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BOARD OF PUBLIC WORT S <br />AGENDA ITEM REVIEW BEQUEST FORM <br />Date 06/2212018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 07/10/2018 Phone Extension 5920 <br />9peAired Prior to,Sobmittalto Board <br />Legal ❑ Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,0010.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />LJ Agreement <br />El Professional Services <br />F-1 Bid Opening <br />R Quote Opening <br />F] Change Order No. <br />El Ease/Encroach. <br />F] Other: <br />LJ Contract <br />R Resolution <br />n Bid Award <br />El Quote Award <br />❑C/O & PCA No <br />❑ Traffic Control: <br />Company or Vendor Name, <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />lure 0 =10-1 I <br />0 Req. to Advertise <br />Ziolkowski Construction, Inc. <br />FAT5MT g 0 , q <br />F1 Title Sheet <br />El Yes El No El If Yes, Approved by Purchasing <br />[:] ABER WBE <br />0 No El Yes Name of Company <br />2017 Curb and Sidewalk, Divisions B, C, D, E & F <br />117-008 <br />Funding Source MVH <br />Account No. 202.0619A31.31.06 <br />Amount $ 268,381.00 <br />Terms of Contract <br />Purpose/Description Project Closeout <br />E:1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-VerifV, Ira- etc N <br />0 <br />Amount of El increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />R <br />El <br />F-1 <br />El <br />El <br />