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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW It QUEST FORM <br />Date 02/05/2018 <br />Name Toy Villa Department Engineering <br />BPW Date 02/13/2018 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal F1 Attorney Name <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />H Agreement H Contract LJ Proposal Ll Addendum <br />F1 Professional Services n Resolution <br />❑ Bid Opening El Bid Award Req. to Advertise ❑ Title Sheet <br />Quote Opening El Quote Award <br />Change Order No. 2 ❑ C/O& PCA No. ❑ PCA <br />Ease/Encroach. Traffic Control <br />El Other: <br />F Required Information <br />Company or Vendor Name <br />Gibson -Lewis, L,LC <br />New Vendor <br />El Yes M No El If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />[:] MBE [:] WBE <br />MBEANBE Contractor RequestedE] <br />No [:] Yes Name of Company <br />Project Name <br />Charles Black Center Renovation <br />Project Number <br />116-073 <br />Funding Source <br />Park Bond <br />Account No. <br />Park Bond: 751.1101.452.39.,89 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Approval of C.O. #2 <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.), <br />Required For Change Oroers,Only <br />Amount of Increase $73,726,00 <br />F] Decrease $ <br />Previous Amount <br />$ 3,812,520.00 <br />Current Percent of Change: <br />1.93% <br />New Amount <br />$ 3,886,246.00 <br />Total Percent of Change: <br />2.38% <br />Dispersal After Approval <br />Copy Original <br />F-1 n <br />1:1 El <br />n n <br />