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BOARD OF PUBLIC WORK <br />AGENDA ITEM REVIEW REQUEST FORM <br />I1. <br />Name Kyle Silveus Department Engineering__ <br />BPW Date 08/14/2018 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name Clara McDaniels <br />Controller Ei Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El Michael Schmiidt <br />Check the Appropriate Item Type — RequJiredd for All Submissions <br />F-1 Agreement <br />El Contract E] Proposal ❑ Addendum <br />El Professional Services <br />R Resolution <br />El Bid Opening <br />El Bid Award Req. to Advertise F-1 Title Sheet <br />El Quote Opening <br />El Quote Award <br />R Change Order No. <br />F1 C/O & P,CA No. ❑ PGA <br />F-1 Ease/Encroach. <br />❑ Traffic Control <br />F-1 Other: <br />Required Information <br />Company or Vendor Name <br />TBD <br />New Vendor <br />El Yes 0 No F-1 If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />[:] MBE F-1 WBE <br />MBE/WBE Contractor Requested E:1 No F-1 Yes Name of Company <br />Project Name <br />Gemini Washington -Colfax Apartment Improvements� <br />Project Number <br />118-08 OA <br />Funding Source <br />West Washington TIF <br />Account No. <br />Amount <br />$ TBD <br />Terms of Contract <br />Base bid <br />Purpose/Description <br />Repair of Apartment Building Roof 1 along' ashington St. <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verif , Iran, etc.) <br />Required For�Chan `e OrdersnI... <br />Amount of F11 increase $ <br />F-1 Decrease $ <br />Previous Amount <br />-'*Ar& <br />Current Percent of Change: <br />% IDT J?UJ6Ji,. W,, <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original I <br />:7421r!t��11 7-7/7 <br />El <br />El El <br />