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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REI VIEW REQUEST FORM <br />Date 7/02/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 7/10/2018 Phone Extension 5920 <br />Required Prior to Submittal to8Qard <br />Legal E:1 Attorney Name-, <br />Controller El 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 />a a - a , _01 <br />H Agreement <br />F-1 Professional Services <br />[:1 Bid Opening <br />El Quote Opening <br />Z Change Order No,/_I"�f\ <br />F] Ease/Encroach. <br />F-1 Other: <br />L] Contract <br />Resolution <br />❑ Bid Award <br />F1 Quote Award <br />F1 C/0 & PCA No. <br />El Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />C & E Excavating, Inc, <br />amTeem, <br />Um <br />Addendum <br />El Title Sheet <br />El Yes M No El If Yes, Approved by Purchasing <br />E] MBE 0 WBE <br />F1 No El Yes Name of Company <br />Ironwood Drive Pavement Rehabilitation and Intersection <br />117-071A <br />Local Road & Bridge Grant <br />265.0608.431.36.10 <br />Ar)r)roval of C.O. #2 <br />[I Required Contractor's Certification 11=orms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E,-Verifv, Iran, etc. <br />Amount of Increase $18,955.50 <br />Decrease $ <br />Previous Amount $ 1,347,592.50 <br />Current Percent of Change: 1 A0% <br />New Amount $ 1,371,163.80 <br />Total Percent of Change: 1.75% <br />Copy <br />Original <br />n <br />n <br />E] <br />0 <br />El <br />El <br />