Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/06/16 <br />Name Toy Villa 1V 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 All Submissions <br />❑ Agreement ❑ Contract ❑Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <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 />Required Information <br />Rieth Riley Construction Co., <br />Ll Yes ® No ❑ If Yes <br />I -I MBE I -I WBE <br />No ❑ Yes Name of <br />114-085A <br />TIF Infrastructure <br />0 <br />Project Closeout <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non-DPharmant F-Vprifv Iran ate <br />Increase <br />Decre; <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />For Change Orders On <br />$1,838,183.83 <br />5.29% <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ Mike Divita, Ji <br />® <br />❑ Roger Nawrot <br />® <br />❑ Toy Villa <br />Love <br />