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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/17/2018 <br />Name Toy <br />Villa <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date 12/20/2018 Phone Extension 5920 <br />Required to Submittal to Board <br />Legal Attorney Name: <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 />LJ Agreement Amendment <br />Professional Services <br />Bid Opening <br />�] Quote Opening <br />Change Order No. 2 <br />Ease/Encroach. <br />Other: General Release <br />Company or Vendor Name <br />a ro riate Item Ty :.... o ired for All Submissions <br />El Contract Proposal <br />El Resolution <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Award <br />El C/O & PCA No. ❑ PCA <br />�I Traffic Control: <br />.....Re aired Information <br />Williams Creek Manement Corporation <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />L__J Yes LJ No <br />rchasina <br />17 M.B....... . <br />E J-1 WBE <br />. aan <br />........._ No m mw Yes Name of Com .�-�.�.�......��n <br />_Ravina Park - Bank Stabilization <br />Special LOIT - Major Proiectsmm <br />257.0608.431.42.96 <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For CarMgOrders Onlymmm <br />Amount of Increase $ <br />® Decrease $ 26,810.80�� <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />$ 244,899.20 <br />1.78% <br />$ 249,169...00 <br />Disrrersal After A <br />Copy <br />Original <br />® <br />❑ Kara Boyles, City Engineer <br />® <br />F] Alicia Czarnecki �� <br />