Change Order No 1 - Navarre St Milling and Asphalt Overlay Project No 117-128 - Walsh & Kelly

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/04/2018 Name Su�.....��.._�. �... e Ellen Doudrick Department Division/Bureau Public Works Engineering BPW Date 12/11/2018 Phone Extension 5922 Required Prior to Submittal to Board Legal Attorney Name: Controller Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing EJ Check the ❑ Agreement Amendment ❑ Professional Services ❑ Bid Opening ❑ Quote Opening ® Change Order No. 1 ❑ Ease/Encroach. C-1 Other: General Release Yropriate Item El Contract El Resolution ❑ Bid Award ❑ Quote Award C/O & PCA No. El Traffic Control: Company or Vendor Name New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description for All Submissions G Proposal ❑ Req. to Advertise uired Information ❑ PCA Addendum ❑ Title Sheet Walsh & Kelly, Inc. F wYes No If Yes, Approved b Purcha iasin mmm mm mm mmmmmmmm .. .[�. MBE WBE No 0 Yes Name of Company Navarre Str.............andAsphalt 117-128 .—a._.. ... ............... Low K 5fF 251.0608.431361 _..... Approval of C.O. #1 ❑ Required Contractor's Certification Forms Attached (Non - Collusion Non -Discrimination, Non -Debarment, E-Verify, Iran etc. ...................... ..................... required For Chace OrdersmOrlr Amount of ® Increase 7,000-0m0mmmmmmmmm............................._._._ w w Decrease 2,�503.��..6�6��......_wm �...................�..� wm�. �.�.. Previous Amount Current Percent of Change: 1 —...�__.........�.._ 6.47% New Amount $ 49,503.50 Total Percent of Change . ...._....._....1...6..47% ... ........ ....... ....wwww wr Dispersal After Approval Copy Original ❑ ❑I El