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BOARD OF PUBLIC' WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/15/2018 <br />Name Toy Villa ­� Department -Engineering <br />BPW Date 05/22/2018 Phone Extension 5920 <br />... . ...... . —­ . .... . ......... <br />mm <br />Required Prior to Submittal to Board_ <br />Legal ❑ Attorney Name <br />Controller ❑ 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 />" Agreement <br />F-1 Professional Services <br />[:] Bid Opening <br />[J Quote Opening <br />M Change Order No. 17 <br />F] Ease/Encroach. <br />F1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBEAAIBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />F-1 <br />H Contract H Proposal Addendum <br />F-1 Resolution <br />F-1 Bid Award ❑ Req. to Advertise Title Sheet <br />R Quote Award <br />F-1 C/O & PGA No. E] PCA <br />E] Traffic Control <br />Required Information <br />Rieth-Riley Construction Co., Inc. <br />-E] Yes M No E] If Yes, Approved by Purchasing <br />E] MBE [:] WBE <br />El No El Yes Name of Company <br />South Bend One -Way to Two -Way -Conversion <br />.116-001 <br />Building & Street Maintenance <br />202-0607-43136-01 <br />21 <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discri ruination„ Non-Debeirment, E-Verify, Iran, etc. <br />Increase $26,149.29 <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />El <br />n <br />El <br />n <br />El <br />$ 17,770,622.55 <br />0.15% <br />$ 17.796.771.84 <br />--10.32% <br />Dispersal After Approval <br />