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BOARD OF PUBLIC WOIUKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/29/2018 <br />Name Toy Villa ­'<? Department —Engiineering <br />BPW Date 06/12/2018 Phone Extension 5920 <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 />Purchasing El <br />F1 Agreement H Contract LJ Proposal LJ Addendum <br />[:] Professional Services F] Resolution <br />E:1 Bid Opening 0 Bid Award 0 Reg. to Advertise El Title Sheet <br />F-1 Quote Opening El Quote Award <br />E Change Order No. 2 ❑ C/O & PCA No. E] PCA <br />F-1 Ease/Encroach. Traffic Control <br />F Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBENVBE Contractor <br />Reg nested <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 />F-1 Yes R1 No F-1 If Yes, AoDroved by Purchasinci!, <br />MA FZT: IN <br />El No El Yes Name of Company <br />2017 Central Services Remodel <br />117-118 <br />Capital Bud�get____ <br />224.0605.419A3.10 <br />Approval of C.Q. #2. <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of H Increase $2,859.00 <br />E] Decrease $ <br />Previous Amount $52,399.00 <br />Current Percent of Change: 5.4610 <br />New Amount $55,258,00 <br />Total Percent of Change: 19,03% <br />Dispersal After Approval <br />Copy Original <br />M [J Mary Wisnewski <br />El F-1 <br />El El <br />