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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/06/16 <br />Name Toy Villa /� Department Engineering <br />BPW Date 12/13/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for A// Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Re to Advertise <br />❑ Quote Opening ❑ Quote Award q' Title Sheet <br />❑ Change Order No. ® C/O & PCA No. 7 Final ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Increa <br />Decre; <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />Required <br />Rieth Riley Construction Co., Inc. <br />❑ Yes Z No ❑ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />U No LJ Yes Name of Company <br />Western Avenue Corridor Improvements <br />11 <br />Major Moves & River West TIF <br />412.0602.431.42.03 & 324.1050.460.42.03 <br />Project Closeout <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc. <br />uired For Change Orders <br />l . t$Z% <br />$ 955,346.70 <br />-7.92% <br />Dispersal After Approval <br />Aaron Kobb, Judy Love <br />T <br />Villa <br />