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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />0�9/17/2018 <br />ON= <br />Department <br />BPW Date 09/25/2018 Phone Extension 5920 <br />Required Prior to Submittal to Beard <br />Legal E] Attorney Name <br />Controller 0 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 El <br />F1 Agreement <br />❑ Contract L Proposal LJ Addendum <br />EJ Professional Services <br />Resolution <br />Bid Opening <br />n Bid Award F-1 Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />F-1 Quote Award <br />Z Change Order No. 1 <br />n C/O & PCA No. E] PCA <br />❑ Ease/Encroach. <br />F-1 Traffic Control <br />Other: <br />Company or Vendor Name Martell Electric, LLC <br />New Vendor E] Yes 0 No E] If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE F-1 WB,E <br />MBEANBE Contractor Requested 0 No F-1 Yes NameofCompany <br />— <br />Proiect Name Liaht LID South Bend — Riverside Licihtinq <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />118-01 1A <br />COIT <br />404,-0602-431.31-06 <br />Retrofittin.q the luminaires on existing lights <br />Required Contractor's Certification Form Attached (Non_ <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of 0 increase $ 6,512.00 <br />F-1 Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount $95,228,00 <br />Total Percent of Change: 7.34% <br />Dispersal <br />Copy Original <br />M F-1 Kara Boyles <br />E 0 Alicia Czarnecki <br />11 El <br />