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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 28, 2018 <br />Name Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date October 9, 2018 Phone Extension 5932 <br />Re aired Prior to Submittal to Board <br />Legal ❑ Attorney Name: Clara McDaniels <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 />U Agreement <br />U Contract U Proposal LJ Addendum <br />❑ Professional Services <br />❑ <br />Resolution <br />❑ Bid Opening <br />❑ <br />Bid Award ❑ Req. to Advertise ® Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />M Other: Amendment #1 <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBEIWBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of U Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />DLZ Indiana, LLC <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />Purchasing <br />® MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Century Center Damage Inspection Report <br />118-082 <br />Liability Insurance <br />226-0419-672.43-02 Code cc2018 <br />$38,400.00 The total amount is changed to $49,900.00 <br />Not to Exceed <br />Prepare construction bid documents with services during bidding <br />and construction to repair the damaged floor slabs and walls in <br />the lower level north restrooms and appurtenances. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />p�0 <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />