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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/2018 <br />Name Sue Ellen Doudrick <br />Department BPW <br />Division/Bureau Engineering <br />BPW Date 12/20/2018 Phone Extension 5922 <br />wmrv�ur amuuuuuummwwwwwwwwwwwwwwwwww�uwwwwww�uwwwww wwimuwimuwimmmuemrmxwmmmmuimw mnmi aw�m�mrmvmommm mrsmam mmrere�rcaw,mu�mimu�rt uarrr�mmmPow smuummmmnmmmmmuuuuuuuuuuuuuuuuuulI ia�, m r,�: �ro�ry <br />_........ �e q qired Prior to Submittal to Board <br />Legal ❑ Attorney Name: Clara McDaniels <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 <br />[� Agreement Amendment m <br />Professional Services <br />id Opening <br />Quote Opening <br />Change Order No. <br />❑ Ease/Encroach, <br />li Other: <br />Company or Vendor Name <br />?p(qp late Item T� - <br />❑ Contract <br />esolution <br />ew <br />Bid Award <br />uote Award <br />❑ C/O &PCANo. <br />_ <br />❑ Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />or All Submissions <br />Proposal <br />❑ Req. to Advertise <br />fired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Ritschard Bros.. <br />.�. <br />❑ Yes ®.No...._.u.w�w�______ ❑ I .....�����.............�__ y _...�_.............. <br />.�.A <br />If Yes, Approved b <br />Purchasin <br />MBE W B E <br />-_O.v� � _ ............� ­"­' <br />No Yes Name of ComDanv <br />Project Name <br />....'.°Three Twenty Cascades,,.....-............. Site UtilitiesLLLL <br />Project Number <br />118-074 D <br />FundingSource <br />River East ���������.�.......... <br />t TIF <br />Account No. <br />429 <br />Amount <br />�$51,423.50 (Division B -Sanitary) �L�...........�.......................a��. <br />Terms of Contract <br />�...... ��m ....... .. <br />Unit prices <br />Purpose/Description <br />Site Utilities (w.......ater, sewer, storm) for the Cascades <br />development at 320 E. Colfax <br />_ <br />Required Contractor's Certification Forms Attached Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_.. w.. _.._..... _ _ ._ .... .. <br />_.._ ....... <br />Re tired For Change OrdersvOnl+ _vv_ <br />._._.._ .. m <br />Amount of <br />increase $ <br />_ <br />Decrease $ <br />Previous Amount <br />$ <br />