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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/20/16 <br />Name Toy Villa Department Engineering <br />BPW Date 09/27/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />I Check the Appropriate Item Type — Required for All Submissions <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />® C/O & PCA No. 2 Final <br />❑ Traffic Control <br />Required Informatioi <br />Martell Electric, LLC. <br />El Yes 0 No ❑ If Ye: <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Con <br />2015 Traffic Detector Loops <br />115-045 <br />MVH <br />251.0608.431.36.67 <br />$ 79,171.20 <br />Project Closeout <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Form Attached (Non - <br />For Change Orders <br />Amount of <br />Increase <br />Decrei <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: 9.08% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Pete Kaminski, Terri Swift <br />® ❑ Theresa Harrison <br />® ❑ Toy Villa <br />