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BOARD OF PUBUC WORKS <br />AGENDA ITEM RE VIEW RF',QUEST FORM <br />Date August 22, 2018 <br />Department Public Works <br />Name Roger Nawrot Division,/Bureau Engineering <br />BPW Date August 28, 2018 Phone Extension 5932 <br />PriorR aired to Submittal to Board <br />Legal Z Attorney Name: Clara McDaniels <br />Controller z 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 />H Agreement <br />L-1 Contract L] Proposal ILJ Addendum <br />Z Professional Services <br />El Resolution <br />El Bid Opening <br />F-1 Bid Award Req. to Advertise Z'Title Sheet <br />[] Quote Opening <br />F-1 Quote Award <br />F-1 Change Order No. <br />F-1 C/O & PCA No. F-1 P,CA <br />El Ease/Encroach. <br />F-1 Traffic Control: <br />F-1 Other: <br />Company or Vendor Name DLZ Indiana, LLC <br />E] Yes El No F] If Yes, Approved by <br />New Vendor Purchasing __ . ....... <br />MBE/WBE Contractor M MBE E] WBE <br />MBEANBE Contractor Requested E] No, 0 Yes Name of Company <br />Project Name Damage Inspection Report of the Century Center <br />Project Number 118-082 <br />Funding Source Liability Insurance <br />Account No. 226-0419-672.43-02 Code cc2018 <br />Amount $11,500.00 <br />Terms of Contract <br />Purpose/Description <br />Amount of L] Increase <br />F-1 Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Chanqe-. <br />Copy <br />Original <br />1-1 <br />El <br />El <br />F-1 <br />El <br />1-1 <br />Not to Exceed <br />Conditions report and repair cost estimate for floor slab repair <br />due to a roof drain piping failure in the lower level north <br />restrooms. <br />0 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Chris Dressel <br />Dispersal After <br />