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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST' FORM <br />Date <br />04/17/2018 <br />Department <br />Public Works <br />Name <br />Toy Villa ---vv <br />Division/Bureau <br />Engineering <br />BP W Date <br />04/24/2018 <br />Phone Extension <br />5920 <br />Legal Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,0010.00 or more and <br />greater than, one year in length per the City Purchasing Policy <br />.Purchasing ❑ <br />LAgreement <br />L <br />Contract LJ Proposal L Addendum <br />F-1 Professional Services <br />F-1 <br />Resolution <br />❑ Bid Opening <br />F-1 Bid Award F-1 Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />F1 Quote Award <br />E <br />Change Order No. 3 <br />F-1 C/O & PCA No. ❑ P CA <br />El <br />Ease/Encroach. <br />El Traffic Control: <br />F-1 <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/BE 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 If Yes, Approved by <br />Purchasing <br />[:] MBE [:] WBE <br />El No F1 Yes Name of Company <br />Fire Station #4 <br />116-066 <br />River West TIC Area <br />324,1050.460,36.01 <br />roval of C.O. #3 <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion. Mon -Discrimination. Non -Debarment. E-Verifv. Iran, etc. <br />Amount of M Increase $40,065.00 <br />0 Decrease $ <br />Previous Amount $ 3,310,997.,010 <br />Current Percent of Change: 1.21% <br />New Amount $ 3,351,062,00 <br />Total Percent of Chance: 9,59% <br />Copy <br />Original <br />F <br />F <br />F-1 <br />11 <br />El <br />0 <br />