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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/01/2018 Department Public Works <br />❑ Agreement Amendment <br />U Contract H Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />® Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />❑ Other: <br />Company or Vendor Name <br />�} <br />❑ Yes 'No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEIWBE Contractor <br />❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />West Race Emergency Repairs <br />Project Number <br />115-115 <br />Funding Source <br />Hotel -Motel <br />Account No. <br />7304.42010.000.0099 <br />Amount - <br />f 914 I b 6 <br />Terms of Contract <br />Unit Prices <br />Purpose/Description <br />West Race of St. Joe River -- remove and replace stop logs and <br />reset planks downstream of West Race Gate. Damage to some <br />of the existing stop logs and planks due to February 2018 flooding <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />