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BOARD OF PUBLIC WOIZICS <br />AGrENDA ITEM REVIEW REQUEST FOItM <br />Date 08/20/2018 Department Public Works <br />Name, Toy Villa Division/Bureau Engineering <br />BPW Date 08/28/2018 Phone Extension 5920 <br />Legal El 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 <br />H Agreement Amendment H Contract U Proposal LJ Addendum <br />n Professional Services n Resolution <br />El Bid Opening F-1 Bid Award El Req. to Advertise El Title Sheet <br />[:1 Quote Opening 0 Quiote Award <br />F-1 Change Order No. F] C/O & PCA No. M PCA <br />n Ease/Encroach. F] Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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 />HRP Construction Co., <br />West Race Emergency Repairs <br />115-115 <br />Hotel -Motel <br />7304,42010,000,01099 <br />$93,250.00 <br />Project Closeout <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersql After Appl9val <br />Copy Original <br />F-1 F-1 <br />El F-1 <br />