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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/08/2019 Department Public Works <br />. <br />Name Toy <br />....... <br />y Villa/Alicia Czarnecki Division/Bureau Engineering <br />.... <br />. ......... . <br />BPW Date 01/22/2019 Phone Extension 5920 <br />.. wwwW+.�,r .. iwwwwwwwwwwwwwuwmmmuwimuuerm�wrtaucnrmx... �a�rnmwm� ism „ - rwmnrmm�rmmmmuuuuuuuuuuuumumummuw iem �rm�w�wmmomomomomo�.mmm�ommmwwwmw�s� <br />Red red Prior 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 />Agreement Amendment <br />❑ Professional Services <br />F-1 Bid Opening <br />El Quote Opening <br />0 Change Order No. <br />Ease/Encroach. <br />F Other: General Release <br />Company or Vendor Name <br />Trpriate Item Type — <br />R Contract <br />El Resolution <br />d for All Submissions <br />Proposal <br />❑ Bid Award EJ Req. to Advertise <br />❑ Quote Award <br />® C/O & PCA No. 3 Final ❑ PCA <br />❑ Traffic Control: <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 />Required Information <br />�.._9. .. rporation <br />Williams Creek Mana ement Co <br />UYes LNo <br />Purchasina <br />MBE �_ WBE _ <br />No F-I Yes Name of Compan <br />Ravina Park — Bank Stabilization <br />117-073A.............................._.................. <br />Special LOIT — Mayor Proiects <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 Change Orders Only <br />increase <br />Amount of Decrease $ �� .. <br />3,125.30 <br />Previous Amount $ 249,269.00_............................_.m.... <br />Current Percent of Change: - 1.25% <br />New Amount $ 246,143.70 ww _r_ .... �............_ <br />Total Percent of Change, 9.41 % <br />m ...� <br />.._ ... . ....................................... .. Dispersal After Ap <br />pro va.1...- <br />Copy Original <br />® Kara Boyles, City Engineer <br />Z El Alicia Czarnecki <br />