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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/02/2018 Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />... ...... . ..... . . .... <br />BPW Date 11/13/2018 Phone Extension 532 <br />............ --"- .. <br />Re---quired Prior to Submittal to Board <br />­­­ ................... <br />.. ...___­ ............ . . . —"—.i'_ ........... . . .. ... ...... — <br />Legal [:] Attorney Name. - <br />Controller E] 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 />Check the <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. 6 <br />Ease/Encroach. <br />Other: <br />ir9priate Item T y <br />M Contract <br />El Resolution <br />El Bid Award <br />F] Quote Award <br />F� C/O & PCA No. <br />F-1 Traffic Control: <br />,,d fo <br />r or All Submissions <br />F] Proposal <br />E] Req. to Advertise <br />Reggired Information <br />F-1 PCA <br />Addendum <br />El Title Sheet <br />Company or Vendor Name <br />Walsh & Kelly, Inc. <br />E Yes® No El If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />MBE WBE <br />MBEANBE Contractor Requested <br />No - - ­ Yes Name of Comp�)qy <br />Project Name <br />Downtown East-West Streetscapes <br />— - — ------- ...... <br />Project Number <br />117-041 A <br />Funding Source <br />RWDA TI F <br />Account No. <br />..... k� U121,701:095 <br />__q <br />Amount <br />Terms of Contract <br />Purpose/Description <br />This a no change in cost invoice that is for a contract time <br />extension of 13 days because of added extra work for the <br />storefront facade replacement. <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />R�Nuired For Change Orders ON <br />. ......... . . ...... <br />Amount of Increase $ , 0.00 <br />F1 Decrease $0.00 <br />Previous Amount $ 1,728,726.22 <br />Current Percent of Change: 0.00% <br />New Amount 1,728,726.22 <br />Total Percent of Change: 4.20% <br />.... ......... . . ... . . ........... ............ <br />Dispersal After Ar)Droval <br />Copy <br />Original <br />F-1 <br />D <br />F-1 <br />F <br />El <br />El <br />