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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/03/2018 <br />Alicia Czarnecki/Tov Villa <br />Department Engineer__..,,,,,, <br />BPW Date 12/11 /2018 Phone Extension 5903 <br />�i�nuwm �ium wowwmmmmmmmuiui rrmum�u� a��w�u�i�uuu�mwwmimwuimumim�rew�mir�auua� <br />or to Submittal to Board <br />....................__._ _ Required Pri_m.. ..__.__. �_......._____ ......._a _... <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 Appropriate Item Type <br />Agreement <br />Professional Services <br />F-1 Bid Opening <br />❑ Quote Opening <br />® Change Order No. 3 <br />El Ease/Encroach, <br />El Other: <br />H Contract <br />❑ Resolution <br />❑ Bid Award <br />R Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />Proposal El Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />!red Information <br />❑ PCA <br />Company or Vendor Name The Robert. Henry Cor oration <br />New Vendor Yes ❑ No R If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE E WBE <br />MBE/WBE Contractor Requested ❑ No [:] Yes Name of Company <br />Project Name VPA Maintenance Storage Building <br />Project Number 118-046R <br />Funding Source Park Bond Series I <br />Account No. 471-1138._...................................._.,,,,,,,,, <br />452.42-01 <br />Amount $ <br />Terms of Contract <br />Purpose/Description Approval of C.O. #3 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-V rif�lran, etc. <br />w� <br />Requir+ d ForChange Orders Only <br />Amount of ® Increase $ 38,936.00 <br />Decrease $ <br />Previous Amount .. �..............................5.............. ' <br />_348,9 4.00 <br />Current Percent of Change: 11.16% <br />New Amount $387,890.00 <br />Total Percent of Change: 17.48% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Toy Villa <br />❑ ❑El 0 <br />.... <br />