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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/06/2018 <br />Patrick Sherman <br />Department VPA <br />BPW Date 12/11/2018 Phone Extension 5601 <br />mmwmmmmm�mmimimimmmmmmuiuwwmim: wwrwmarm wtmrwuumr <br />mmr�w�mmnmmmmmnmmlw m= <br />�mRcquired Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Michael Schmidt <br />Check the <br />LJ Agreement <br />[] Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. _ <br />�] Ease/Encroach. <br />❑] Other: <br />ro riate wItem Type — <br />Contract <br />Resolution <br />Bid Award <br />E, Quote Award <br />�! C/O & PCA No. _ <br />Traffic Control <br />for All Submissions <br />.w ITIT ._. Addendum <br />� Proposal <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />Company or Vendor Name R. Yoder Construction <br />/1 ' <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested [:1 No ❑ Yes Name of Company <br />Project Name <br />Rum Village Doi Park Construction <br />Project Number <br />1060-2018 <br />Funding Source <br />2015 Park Bond <br />Account No. <br />751-1101-452-39.89 <br />Amount <br />�.. w_.......-.-.m-.. _m .............. ��������A... .. <br />$ 143,257.31 <br />Terms of Contract <br />... <br />Purpose/Description P__.............mw. <br />ro ect Closeout <br />Required Contractor's Certification Form Attached (Non- <br />.... _ ..... Collusion, Non -Discrimination, Non -Debarment, -Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of El Increase $ <br />[❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />El <br />❑ <br />El <br />E] <br />F] <br />Dispersal After Approval <br />........................ <br />