Change Order No 1-PCA - Ameritech Dr Pavement Improvements Project No 117-057A - Walsh and Kelly Inc

Home Browse Search

BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/04/2018 Name Toy Villa Department Public Works Division/Bureau Engineering BPW Date 12/11/2018 Phone Extension 5920 a�oaw �umw�i�mmmuim Hamm mmmommmm= i _...... .._.�_........ �,�, ... .... ..... ..._....__.__.. _.. �..,..-- --------- W Bored Prior to Submittal to Board Legal ❑ Attorney Name: _�........___....... �-. �........._... �....... mm.......... 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 ❑ Check the Agreement El Professional Services E] Bid Opening Quote Opening F-1 Change Order No. _ Ease/Encroach. F� Other: iropriate Item_Ty EJ Contract Resolution [� Bid Award ❑� Quote Award ® C/O &PCANo ❑ 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 Amount of — Re lyked for All Submissions [❑ Proposal ❑ Req. to Advertise 1 Final ❑ PCA Required Information & Walsh _Kelly„ Inc. alsh [� YesNoIf Yesn Aoproved by Purchasi MBE mWBE No Yes Name of Com an .��. Ameritech Drive Pavement Improvements 117-057A - ....w_. ...... 324.1050....._ _......... 460.31.20 Proiect Closeout Addendum ❑ Title Sheet ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E Verify, Iran, etc. o uirq ed For Chaps Orders Onl +w w ww Increase $ Decrease ^$ 1....., 9563.96 Previous Amount Current Percent of Change New Amount Total Percent of Chance: Copy Original ❑ ❑ 389,000.00 5..03°/.........m.mm ...._ ..... $ 369,436.04 5.03% Dispersal After�Aproval.....�ww .........�.....��...��......�� ...