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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 30, 2018 <br />Name Alicia Czarnecki <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 11, 2018 Phone Extension 5903 <br />�ii mmmmmmmmmmimlmmmmm��IIIIIIIIIIIIIIIIIIIIIIIilmlIHIHIMWWHI <br />Re uired 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 (l <br />Check the <br />LJ Agreement Amendment <br />El Professional Services <br />Bid Opening <br />Quote Opening <br />E] Change Order No. <br />Ease/Encroach. <br />Other: <br />iro riate Item Type—ITR'ufired for All Submissions <br />El Contract Proposal <br />Resolution <br />® Bid Award ❑ Req. to Advertise <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control: <br />Required Information <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name Brown_& Brown General Contractors„ Inc. <br />Yes" No If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor MBE 0 W B E <br />MBE/WBE Contractor Requested mw....ro�.� m...... <br />q ❑ No ❑Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of Increase <br />Decrease <br />Previous Amount $ <br />................ <br />Current Percent of Change: <br />................. <br />New Amount $ <br />Total Percent of Change: <br />South Ben <br />d Fire Department Training Center Classroom Building m...... <br />2m01m8mmFire Station ��........ �w m. <br />_ on #9 Capital <br />. 451-0901-422.42-02..._.. ................. .�... __. w..._...__ �. <br />00 <br />A new 3000 sf building with SBFD classrooms on the site of the <br />Fire Training Center <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />luired For C!)r 9ge_Orders 0. <br />HM� .1 MOO � <br />Copy Original <br />® ❑ Kara Boyles, City Engineer _ <br />teve Cox, Fire Chief and Todd Skwarcan. Asst. �Fi....w �...�.�.........................��....... <br />re Chief <br />❑ ❑ <br />