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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/14/2018 <br />Name Alicia Czarnecki/Sue Ellen Doudrick Department Engineering <br />. ......__....._ ........... . <br />BPW Date 12/20/2018 Phone Extension 5903 <br />_.._ ... _ . <br />a <br />Required Pr R 9 for to Submittal to Board <br />.�._mm_._.......__. <br />Legal <br />....._.��. . <br />® Attorney Name Clara McDaniels <br />Controller <br />® 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 />® Michael Schmidt <br />.. _............. <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement <br />_____...... <br />j.�l Contract [� Proposal Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />....—_...... <br />Required Information <br />p a n y r Vendor Name Division A: Rieth Rile Construction Co. Inc. / <br />Division B & Alt. 131 B2 &B3. Walsh & Kelly, Inca Inc. <br />New Vendor <br />❑ Yes ® No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />McKinley Avenue and Fremont Park Improvements ................. <br />Project Number <br />118-072 <br />Division A:LRSA Utility Expense Contractual mServiceWFund ($92,017.00) <br />Division B: LRSA Utility Expense Contractual Service Fund ($102,200.00) <br />Alt. 131: LRSA Utility Expense Contractual Service Fund ($63,800.00) <br />Alt. 1132: MVH ($22,440.00) <br />Funding Source <br />Alt. 1133: VPA ($25,000 00),-MVH ($31,100 00 <br />Division A: 251.0608.431.42.96 ($92,017.00) <br />Division B: 251.0608.431.42.96 ($102,200.00) <br />Alt. 131: 251.0608.431.42.96 ($63,800.00) <br />Alt. 132: 202.0607.431.36.01 ($22,440.00) <br />Account No. <br />Alt. 133: 201.1101.452 36.01 ($25w000.00 , 202-0619-431 IT31-06 ($31,100.00) <br />Amount <br />Division A: $92,017.00 / Division B & Alt. B1,B2,&B3: $244,540.00 <br />... ...w <br />Terms of Contract <br />....._............a.......�w .�_ <br />Purpose/Description <br />❑ Required Contractor's Certification Form Attached (Non- <br />........ <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />w .....r <br />Required For Change Orders Only 1 <br />Amount of <br />� <br />$ .............. .�... <br />Decrease <br />se <br />s$ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % w <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kara Boyles <br />