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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />03/06/2018 <br />Department <br />Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />- <br />Engineering <br />BPW Date <br />03/13/2018 <br />Phone Extension <br />5920 <br />Legal <br />Controller <br />Purchasing <br />F Attorney Name: <br />El 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 />El <br />LJ <br />Agreement <br />L] Contract LJ Proposal LJ Addendum <br />F-1 <br />Professional Services <br />El <br />Resolution <br />�R Bid Opening <br />0 <br />Bid Award E] Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />F-1 <br />Quote Award <br />Change Order No. 2 <br />❑ C/O & PCA No. E] PCA <br />El Ease/Encroach. <br />❑ Traffic Control. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Gibson -Lewis, LLC <br />El Yes El No E] If Yes, Approved by <br />Purchasing <br />E] MBE [J WBE <br />R No El Yes Name of Company <br />Fire Station #4 <br />116-066 <br />River West TIF Area <br />324.1050.460.36.01 <br />Approval of C.O. #2 <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion. N on-Discrim i nation, Non -Debarment. E-Verifv, Iran, etc. <br />Amount of H Increase $ 103,055.00 <br />F1 Decrease $ <br />Previous Amount $ 3,207,942.00 <br />Current Percent of Change: 3.21% <br />New Amount $ 3,310,997.00 <br />Total Percent of Change: 8,28% <br />Copy <br />Original <br />F-1 <br />E] <br />El <br />F-1 <br />El <br />F] <br />