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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE VIEW REQUEST FORM <br />Date 06/1512018 Department <br />Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 06/26/2018 Phone Extension 5920 <br />� aired Prior to ;abmittal too �c��,rd <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 />❑Agreement Amendment <br />Contract ❑ Proposal H Addendum <br />F] Professional Services <br />F1 Resolution <br />E] Bid Opening <br />0, Bid Award El Req. to Advertise F-1 Title Sheet <br />F-1 Quote Opening <br />F1 Quote Award <br />Z Change Order No. 1 <br />❑ C/O & PCA No. El PCA <br />n Ease/Encroach. <br />❑ Traffic Control,* <br />F-1 Other: <br />Company or Vendor Name HRP Construction Co. <br />New Vendor ❑ Yes No ❑ If Yes, Approved <br />MBE/WBE Contractor ❑ MBE 0 WBE <br />MBEIWBE Contractor Requested ❑ No L] Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />West Race Emergency Repairs <br />115-115 <br />Hotel -Motel <br />7304.42010.000.0099 <br />Terms of Contract <br />Purpose/Description Approval of C.O. #1 Final) <br />_ <br />E]Required Contractor's Certification Forms Attar-h,ed (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Requir <br />Amount of Increase $9,150.00 <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of C <br />Copy <br />Original <br />❑ <br />F1 <br />0 <br />n <br />10.88% <br />$93,250.00 <br />10.88% <br />