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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05,/02/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 05/22/2018 Phone Extension 5920 <br />Legal F-1 Attorney Name: <br />Controller 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 />Purchasing El <br />H Agreement Amendment <br />LJ Contract <br />LEI Proposal LJ Addendum <br />R Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />n Bid Award Req. to Advertise E] Title Sheet <br />El <br />Quote Opening <br />F1 Quote Award <br />ZI <br />Change Order No, 1 <br />El <br />C/O & PCA No. ❑ PCA <br />F-1 Ease/Encroach. <br />Traffic Control: <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />Pemberton Davis Electric, LLC. <br />Yes N No El If Yes, Approved by <br />Purchasing <br />F-1 MBE [-] WBE <br />El No 0 Yes Name of Company <br />FUR Traffic Cameras <br />117-122 <br />LRSA - Traffic Signai Maintenance <br />251 -0�608-431.36-67 <br />Approval of C. O. #1 <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of M Increase $6,928.00 <br />F-1 Decrease $ <br />Previous Amount <br />Current Percent of Chang( <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />El <br />F-1 <br />n <br />1-1 <br />El <br />$ 104,920.00 <br />&60% <br />$ 111,848.00 <br />6.60% <br />Dupers <br />