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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/4/2018 <br />Name Krle Silveus Department Engineer!n _......_. <br />BPW Date 12/11/2018 Phone Extension 9083 <br />oou�m�o uwmrmmm re�uuuuuuuuuummwwm�rtwrcra�m!�mrmrwvrnmwr�r r�®r�rwm more�n a�,���,�y <br />Required Prior to Submittal to Board <br />�......._. _ ........ ...................... _. __.. <br />Legal AttorneyName Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing �] Michael Schmidt <br />Check the <br />Agreement <br />(l Professional Services <br />❑ Bid Opening <br />Quote Opening <br />Change Order No. 3 <br />El Ease/Encroach. <br />EI Other: <br />Nropriate Item Tye <br />[I, Contract <br />❑ Resolution <br />El Bid Award <br />�] Quote Award <br />jC/O &PCANo. <br />_ <br />Traffic Control <br />for All Submissions <br />Proposal F-1 Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />❑ PCA <br />Company or Vendor Name Ziolkowski Construction Inc. <br />New Vendor ❑ Yes Z No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE [:] WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Erskine Clubhouse Renovation <br />Project Number 116-108 <br />FundingSource VPA Maintenance�� ����_....................................m........._ <br />Fund <br />Account No. 201.1101.452 39.89 <br />Amount$ 10,471......................._..............................................�� �....�................................................�.�............._��. <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />El <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination Non Debarment, E-Verif , Iran, etc.. <br />Rtjuired For Changqe� Orders Onl,, <br />Increase $ 10,471 <br />Decrease $ <br />Previous Amount $ 914,899.00 <br />14,sgg...........m..........�.......................................�._�ww mm�.......�..................................�.��, <br />00 <br />...........................�.�.�.�.�............. <br />Current Percent of Change:,1...1�4o�� <br />New Amount $ 925,3.............._70.00 . ................ <br />...e.....� <br />Total Percent of Change: 2.03% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kyle Silveus <br />Patrick Sherman <br />