Project Completion Affidavit - Lime Bike Parking Areas Project No 118-059R - The Airmarking Co

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/03/2018 Department Public Works Name Toy Villa Division/Bureau Engineering ........�nn� BPW Date 12/11/18 Phone Extension 5920 remwm� NNorm �w�wwwww!w!wwwwwuw!wwwwumwuuud�m�dre�anw umhwu�wa�aomamomom�ommmu.mm�umm ..�. �y 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 El Check the Agreement Amendment ❑ Professional Services ❑ Bid Opening Quote Opening Change Order No. Ease/Encroach. [-� Other: Rate Item wT�p f Contract Resolution Bid Award ❑ Quote Award ❑ C/O & PCA No. ❑ 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 Proposal ❑ Req. to Advertise Required Information The Airmarking Co ,Inc. El Yes No _......... ❑ If Yes ._ ........ MBE ❑ WBE No [:1 Yes Name of Co m awn .. Bike Parkin se.��-.�..........._� m. 118-059R Complete Streets Transportation 404.1001.460.42.03 .._. .................. ....._______ $9,800 Proiect Closeout Addendum ❑ Title Sheet IF ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Veri r, Iran, etc. � uilred For Change Orders Only Amount of El Increase $ ❑ Decrease $ .................................... Previous Amount $ Current Percent of Changer New Amount $ Total Percent of Chanae: _.........._... Dispersal After Approval Copy Original ❑ E]