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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/06/2018 <br />Name Toy Villa Department Engineering <br />BPW Date 02/13/2018 Phone Extension 5920 <br />=6 <br />Controller <br />Purchasing <br />H Agreement <br />EJ Professional Services <br />El Bid Opening <br />F-1 Quote Opening <br />Z Change Order No. 1 <br />F-1 Ease/Encroach. <br />F-1 Other: <br />El Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />fie Appropriate Item, Type - Regaired forAll, Submissions <br />F-1 Contract E] Proposal D Addendum <br />F-1 Resolution <br />El Bid Award El Req. to Advertise El Title Sheet <br />El Quote Award <br />n C/O & PCA No. PCA <br />F-1 Traffic Control <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBE/VVBE Contractor <br />Requested <br />Project Name <br />Gibsoin-Lewis, LLC <br />�E] Yes E! No [:1 If Yes, Approved by Purchasing <br />KI 11BE N UIBE <br />El No El Yes Name of Company <br />2017 Central Services Remodel <br />Project Number <br />........... <br />117-118 <br />Funding Source <br />Capital Budget__ <br />Account No. <br />224,0605A19.43.1 0 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description, <br />Approval of C.O. #1. <br />R Required Contractor's Certification Form Attached (None <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.Required <br />For Change girders Onl <br />Amount of <br />Increase $ 5,97T00 <br />EJ <br />Decrease $ <br />Previous Amount <br />$46,422.00 <br />Current Percent of Change: 12.88% <br />New Amount <br />$ 52,399.00 <br />Total Percent of Change: 12.88% <br />Dispersal After Approval <br />Copy Original <br />H ❑ <br />Mary Wisnewski <br />F-1 <br />El n <br />