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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />1/15/19 <br />e Silveus <br />Department Enaineerin <br />BPW Date 1/22/2018 Phone Extension 9083 <br />iinimmwwwmimiwww <br />... ... ......_.... . _ ..-- ..... <br />Rouired Prior to Submittal to Board <br />........__ _. �.._.._.._ .�................. <br />Legal El Attorney Name Clara McDaniels <br />Controller 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 El Michael Schmidt <br />Check the <br />Agreement <br />�j Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />® Change Order No. 7 <br />❑ Ease/Encroach. <br />Other: <br />)ropiat lteltem Tyye -- <br />❑ Contract <br />❑ Resolution <br />Bid Award <br />El Quote Award <br />0C/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />1 Proposal R Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />uired Information <br />❑ PCA <br />Company or Vendor Name Ziolkowski Construction Inc. <br />New Vendor ❑ Yes ® No]' If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Erskine Clubhouse Renovation <br />Project Number 116-108 <br />Funding Source <br />Account No. <br />Amount.$2.........................,984 ..........................�. ...��..�_._..m.. <br />Terms of Contract <br />Purpose/Description Porch Repairs due to unforeseen conditions. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion Non -Discrimination„ Non -Debarment, E- <br />_Verif ,Iran, etc <br />RqquIred For..qtqnge, Orders_Only _ <br />Amount of 0Decrease Increase $ 2 984 <br />Previous Amount $ 987,142 <br />Current Percent of Change: 0.3%0 <br />_...............................................�. <br />New Amount $ 990,126.00 <br />Total Percent of Change: 91�6%___�_�__...................�.�.._mm <br />......___.............Dispersal After <br />.Approval <br />Copy Original <br />® ❑ Kyle Silveus <br />® ❑ Patrick Sherman <br />