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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/19/2018 <br />Name Patrick Sherman/Alicia Czarnecki Department Engineering <br />BPW Date 06/26/2018 Phone Extension <br />U Agreement <br />U Contract L] Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />IRI <br />Other: Reiect Bids <br />Company or Vendor Name <br />New .Vendor <br />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />❑ MBE ❑ WBE <br />MBENVBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />VPA Maintenance Storage Building <br />Project Number <br />118-046 <br />Funding Source <br />Park Bond Series I <br />Account No. <br />471-1138-452.42-01 <br />Amount <br />$ TBD <br />Terms of Contract <br />Lump sum base bid with alternates <br />Purpose/Description <br />Storage building extension at Maintenance Division Campus <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />... <br />Re uire; Far Change Orders <br />q <br />Onl <br />Amount of ❑ increase $ <br />❑ Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />