Laserfiche WebLink
BOARD OF PUBLIC WOIZIi,S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/05/2018 <br />Name Toy Villa Department Engineering <br />BPI, Date 02/1312,018 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller El Controller review is required for alll Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing R <br />L_J Agreement H Contract L-1 Proposal LJ Addendum <br />n Professional Services ❑ Resolution <br />F-1 Bid Opening ❑ Bid Award El Req. to Advertise ❑ Title Sheet <br />n Quote Opening ❑ Quote Award <br />Z Change Order No. 1, n C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F-1 Other: <br />Company or Vendor Name <br />Gibson -Lewis, LLC <br />New Vendor <br />❑ Yes Z No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE, Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Charles Black Center Renovation <br />Project Number <br />1'16-073 <br />Funding Source <br />Park Bond <br />Account No. <br />Park Bond: 751.1101.452.39.89 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Approval of C.O. #1 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Nan -Discrimination, Non -Debarment, E-Veri!Y, Iran, etc.) <br />P,,eqqirod,Fbr Change Orders: Only, <br />Amount of Increase $ 16,520.00 <br />❑ Decrease <br />$ <br />Previous Amount <br />$-3,796,000.00 <br />Current Percent of Change: <br />0.44% <br />New Amount <br />$ 3,812,520.00 <br />Total Percent of Change: <br />0.44% <br />Dispersal After Approval <br />Copy Original <br />n El <br />n ❑I <br />El ❑ <br />