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130AIZD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/20/2018 Department Public Works <br />Name Tay Villa Division/Bureau Engineering <br />BPW Date 0�2/13/2018 Phone Extension 5920 <br />ReqL(i,red Prior to Submittal to Board, <br />Legal EJ Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing F <br />H Agreement <br />H Contract LJ Proposal, Addendum <br />El Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />F1 Bid Award El Req. to Advertise E] Title Sheet <br />❑ Quote Opening <br />F-1 Quote Award <br />❑ Change Order No. <br />E C/O & PCA No. 1 (final) 0 P,CA <br />F-1 Ease/Encroach. <br />F1 Traffic Control: <br />El Other: <br />Required Information <br />Company or Vendor Name <br />Walsh & Kelly, Inc. <br />New Vendor <br />El Yes E] No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />=MBE [:] WB-E--- <br />MBEANBE Contractor Requested [:] No E] Yes Name of om an <br />Project Name <br />2017 Curb and Sidewalk, Division A <br />Project Number <br />Funding Source <br />MVH <br />Account No. <br />20Z0619.431.31.06 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Project Closeout <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, INon-Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of E Increase $2,596.00 <br />El Decrease $ <br />Previous Amount <br />$ 109,024.00 <br />Current Percent of Change: Z38% - <br />New Amount <br />$ 111,620.00 <br />Total Percent of Change: <br />2.38% <br />Dispersal After Approval <br />Copy Original <br />ZI n <br />Kara Boyles <br />z El <br />Marcia Qualls <br />E] n <br />