HomeMy WebLinkAboutRequest to Advertise - LLW and Charles Martin Sr Intersection Improvements - Project No 117-072Date
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
05/15/2018
Kvle Silveus
05122/2018
Department Engineering
Phone Extension 5601
Required Prior to Submittal to Board
Legal F-1 Attorney Name Clara McDaniels
Controller ❑ Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing R Michael Schmidt
F-1Contract -1❑' Agreement F El Proposal El Addendum
F-1 Professional Services F'Resolution
F-1 Bid Opening E] Bid Award Req. to Advertise E] Title Sheet
El Quote Opening El Quote Award
F-1 Change Order No. F-1 C/O & PCA No, [:1 P CA
❑ Ease/Encroach. ❑ Traffic Control
Other:
ui:red Information
Company or Vendor Name TBD
New Vendor El Yes El No El If Yes, Approved by Purchasing
MBEANBE Contractor F-1 MBE n WBE
M'BE/WBE Contractor Requested F1 No 0 Yes Name of Company
Project Name LWW Charles Martin Intersection Im
Project Number 117-072
Funding Source RWDA
Account No. 324-1050-460-31.02
Amount $ TBD
Terms of Contract Base bid
Purpose/Description Intersection Improvements at Lincolnway West and Charles Martin
E:1 Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Re aired 1=or Chan`` e Orders C7nl
Amount of ❑ increase $
El Decrease $
Previous Amount
of M13; V
'twllc Wks
Current Percent of Change: % or
New Amount $ 9rM I d
Total Percent of Change: % zV
Dispersal After Approval
Copy Original
❑
F-1 F-1
11 El
rovements