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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date _12/17/2018 <br />Name Kyle Silveus Department Engineering <br />BPW Date 12/20/2018 Phone Extension 9083 <br />... <br />iium remmmmmmmmumiuwuuumuiuiuiuiuiuiuwwwiuw�wwiwiuurrrti�a ..r uummuHuuuuuuummui„�r�ur�rmraruuummimmuuu�mWuuuuuuu����e..� �� . iu�mmmmarsu�rt� .......�.nu. <br />Rye uiir <br />ed PriortoSubmittalto to Board <br />Legal Attorney Name Clara McDaniels <br />Controller ❑I Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />Check the <br />LJ Agreement <br />E] Professional Services <br />Bid Opening <br />El Quote Opening <br />® Change Order No. 3 <br />❑ Ease/Encroach. <br />EJ Other: <br />r_opriate Item Tyww- <br />Contract <br />Resolution <br />Bid Award <br />[�] Quote Award <br />�] C/O & PCA No. <br />Traffic Control <br />for All Submissions <br />I Proposal 0 Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />Company or Vendor Name Sel e Construction Co., Inc. <br />❑ PCA <br />New Vendor Yes EJ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor [:1 MBE WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Im <br />Project Name LWW Charles Martin Intersection movements ............................____ .e... <br />Project Number 117-072A <br />Funding Source <br />RWDA <br />Account No. <br />324-1050-460-42.03 <br />Amount$ <br />9,353...50........................�.,,....................�.�.�.�............................����...�.. �m�.�...................................._..........�. _�� <br />Terms of Contract <br />Purpose/Description <br />�., <br />Add Line Items — Strain Pole Rush,Concreteribbb ons Temporary <br />Strip <br />❑ Required Contractor's Certification Form Attached (Non - <br />...__.._ <br />Collusion, � a _..._w, Iran, etc. <br />ollusion, Non -Discrimination, Non -Debarment, E-Verify, ._.__ <br />Amount of Increase <br />$ 9,353.50„ ..... _„ <br />Decrease $ <br />Previous Amount <br />.....1........................ ,....�.__- � � .�.�. <br />,185,909.53 <br />Current Percent of Change: <br />0.79%���� <br />........... ...............�. <br />New Amount <br />#1�9263.03 <br />5, <br />�.��... <br />Total Percent of Change: <br />...�.�...._— mm....ww �_....�. <br />5.68% <br />Dispersal After Approva.L.....__.........................................�........... ������.......�... <br />Copy Original <br />❑ ❑ <br />❑ ❑,._m..� <br />�....�....._a��__ <br />