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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/15/2018 <br />Department Public Works <br />Name Toy Villa <br />Division/Bureau Engineering <br />BPW Date 02/27/2018 <br />Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ <br />Attorney Name: <br />Controller ❑, <br />Controller review is requiredfor all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type —,Required for All Submissions <br />❑ Agreement <br />❑ Contract El Proposal ❑ Addendum <br />I❑ Professional Services <br />❑ Resolution <br />E] Bid Opening <br />❑ Bid' Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />❑ Quote Award <br />Change Order No. 2 <br />❑ C/O & PCA No. PGA <br />Ease/Encroach. <br />❑ Traffic Control; <br />El Other: <br />Required Information <br />Company or Vendor Name <br />Gibson -Lewis, LLC <br />El Yes ® No If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WWBE Contractor <br />❑ MBE ❑ WWBE <br />MBE/WWBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />2016 Parking Garage Improvements <br />Project Number <br />115-143 <br />Funding Source <br />Major Moves <br />Account No. <br />412-0401-415-36.01 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Fire Alarms at Wayne and Leighton Parking Garages <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only, <br />Amount of Increase $ 44,571.00 <br />El Decrease $ <br />Previous Amount <br />$ 1,160,016,00 <br />Current Percent of Change: <br />3.84% <br />New Amount <br />$ 1,204,587.00 <br />Total Percent of Change: <br />5.20% <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />