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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/13/2.018 <br />Name _ToyVilla Department <br />BPW Date 10/23/2018 Phone Extension 5920 <br />Reauired Prior to Submittal to Board <br />Legal F-1 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 1:1 <br />L] Agreement <br />F-1 Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />E] Change Order No. <br />[] Ease/Encroach. <br />F-1 Other: <br />H Contract <br />M Resolution <br />F-1 Bid Award <br />[:] Quote Award <br />Z C/O & PCA No. I (Final) <br />F-1 Traffic Control <br />Proposal L] Addendum <br />] Req. to Advertise El Title Sheet <br />am <br />Company or Vendor Name HRP Construction, Inc. <br />New Vendor El YesEl No E] If Yes, Approved by Purchasing <br />MBEANBE Contractor [] MBEE] WBE <br />MBEANBE Contractor Requested 0 No 0 Yes Name of Company <br />Mishawaka Avenue — Roto Rooter letter Removal and <br />Project Name Drive Imr)rovements <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Sewer Capital <br />641.0621.792,63.35 <br />Proiect Closeout <br />North Shore <br />[:1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc <br />Amount of F-1 increase $ <br />Z Decrease $21,438.50 <br />Previous Amount $ 45,451.00 <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original' <br />F <br />El <br />E] <br />F-1 <br />E] <br />D <br />-47.17% <br />$24,012.50 <br />-47.17% <br />