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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 12, 2018 <br />Name Becca Plantz <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date December 20, 2018 Phone Extension 5998 <br />mnra mw�mau�mwuu� ew H ,m wmr mmw mmooUMM55555000005 m u uuwuomeeaw�numrcoimrn� uuw amwwmomom�mmmum�ie�wrn <br />......�,....�.�.,...._.... .......... ........,,—..—............. <br />Required <br />ed 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 and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />Agreement Amendment <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />Other: <br />iro riate Item Type — <br />[� Contract <br />Resolution <br />❑ Bid Award <br />® Quote Award <br />El C/O & PCA No, — <br />EJ Traffic Control: <br />for All Submissions <br />I Proposal <br />❑ Req. to Advertise <br />Recluired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name Larson Danielson <br />New Vendor ❑� Yes �No_ If Yes A roved y Purchasdnm� <br />_m�m <br />MBE/WBE Contractor MBE WBE <br />q No Yes Name of Company <br />111 <br />MBE/WBE Contractor Requested <br />Project Name M ... ..�...........��_ .� ...._...� <br />orris Theater Mezzanine Handrails <br />Project Number 118- <br />Funding 9.._ General Fund <br />Account Nource 01 �0404 453 36-01rts Center Gen � „_... ..� <br />Amount$22,900.00 ww����.�..._.............................,�..............................�.�...� ... <br />Terms of Contract Lump Sum <br />Purpose/Description To install handrails in the mezzanine of the Morris Theater <br />mezzanine. <br />Re aired Contractor's Certification Forms Attached hed (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_._..__.. _ .. <br />.. ... , wired For Ch#Rg. Orders Only <br />Amount of <br />.. _.. <br />[� Increase $ <br />] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Charge w % <br />Dispersal After <br />Copy Original <br />0 E] Becca Plantz <br />EJ El <br />❑ 0 <br />va I <br />