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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/05/2018 <br />Name Alicia Czarnecki�ww Department Enaineerin <br />BPW Date 11/13/2018 Phone Extension 5903 <br />equ�irePrior to Submittal to Board <br />. . . ... .. . . ...... . ............ <br />Legal 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 />.................... . ­11­ <br />Check the <br />H Agreement <br />El Professional Services <br />F1 Bid Opening <br />n Quote Opening <br />Z Change Order No. 2 <br />❑ Ease/Encroach. <br />Other: <br />iropriate Item Type <br />Contract <br />Resolution <br />Bid Award <br />F1 Quote Award <br />C/O & PCA No, <br />Traffic Control <br />for All Submissions <br />I Proposal <br />[:] Req. to Advertise <br />uired Information <br />Company or Vendor Name The Robert Henry Corporation <br />E:1 PCA <br />New Vendor El Yes 0 No El If Yes, Approved by Purchasing <br />MBENVBE Contractor F-1 MBE R WBE <br />MBEA/VBE Contractor Requested E] No R Yes Name of Company <br />Project Name VPA Maintenance Storage Building <br />Project Number 118-046R <br />.­­­­­­­­­­ ........ . ..... <br />Funding Source Park Bond Series I <br />Account No. 471-1138-452.42-01 <br />Amount <br />Terms of Contract <br />Purpose/Description Approval of C.O. #2 <br />Addendum <br />El Title Sheet <br />F-1 Required Contractor's Certification Form Attached (Non- <br />. ....... . Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Chancie Orders OnIv <br />Amount of E] increase $ . .... . . ........................................ <br />Decrease 20.00 <br />Previous Amount '$ - 4 -9-74 00 <br />Current Percent of Change,- 0.006% <br />New Amount $ 348,954.00_ <br />Total Percent of Change: 5.684% <br />Dispersal After Approval <br />Copy Original <br />F-1 Toy Villa <br />F-1 1-1 <br />.. .................... <br />El <br />