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BOARD OF PUBLIC WORKS" <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/04/2018 Department <br />Name Toy Villa Division/Bureau <br />IMMI'm <br />Engineering <br />BPW Date 06/12/2018 Phone Extension 5920 <br />Legal Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year lin length per the City Purchasing Policy <br />Purchasing ❑ <br />❑ Agreement Amendment <br />Ll Contract LJ Proposal H Addendum <br />Professional Services <br />F] Resolution <br />F-1 Bid Opening <br />0 Bid Award ❑ Req. to Advertise El Title Sheet <br />E] Quote Opening <br />El Quote Award <br />Change Order No. 1 <br />❑ C/O & PCA No. F1 PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBENVBE Contractor 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 />❑ <br />Pemberton Davis Electric, Inc. <br />El Yes M No El If Yes, Approyed by Purchasing <br />❑ MBE E] WBE <br />No 0 Yes Name of Company <br />FUR Traffic Camera Replacements <br />118-006 <br />LRSA —Traffic, Signal Maintenance <br />- <br />251-0608-431.36-67 <br />Approval of Change Order #1. <br />[:] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $13,756.00 <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />$ 110,110.10 <br />12.49% <br />$ 123,86,6.10 <br />12.49% <br />Copy Original <br />F] Roger Nawrot, Assistant City Engineer <br />F-1 Derick Roberts, Director of Streets & Sewers <br />M 0 Ed Gleckler, Manager Bureau of Traffic & Lighting <br />