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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/03/2018 <br />Name <br />Kara Boyles/Alicia Czarnecki <br />Department <br />Engineering <br />BPW Date <br />10/09/2018 <br />Phone Extension <br />5903 <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 ® Michael Schmidt <br />❑ Agreement <br />a Contract U Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name <br />Walsh & Kelly, Inc. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE [❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Great lakes Capital Spec Building <br />Project Number <br />118-058 <br />Funding Source <br />RWDA TIF <br />Account No. <br />324,1050.460.42.04 <br />Amount <br />$447, 834.20 <br />Terms of Contract <br />lump sum base bid with alternates <br />Purpose/Description <br />Amount of ❑ <br />El <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />