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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/2/2016 Department <br />Public Works <br />Name <br />Richard Estes <br />Division/Bureau <br />Engineering <br />BPW Date <br />8/9/2016 <br />Phone Extension <br />5896 <br />I <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: Michael Schmidt <br />Controller ❑ <br />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 ® <br />George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control: <br />❑ <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Required Information <br />Holladay Construction Group, LLC <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />Purchasing <br />❑ MBE n WBE <br />❑ No ❑ Yes Name of Company <br />Century Center CEO Suites -Suite 17 Remodel <br />116-010 <br />Hotel -Motel Tax <br />7304-42010-0000-0099 <br />$218,062.00 <br />Remodeling to interior rooms including the CEO suites and the <br />bridal suite (suite 17) <br />❑ Required contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />equired For Change Orders Only <br />Copy Original <br />® ❑ Scott Herczeg — Century Center <br />® ❑ Leanna Belew — Century Center <br />® ❑ Bill Lamie — Alliance Architects <br />