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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/18/2019 <br />Name TDepartment Engineering <br />BPW Date 02/26/2019 Phone Extension 5920 <br />w�,,,., End t�i�PriortomSubmittal to Board <br />Legal [] Attorney Name <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 ❑I <br />Check the <br />Agreement <br />El Professional Services <br />Bid Opening <br />Quote Opening <br />® Change Order No. 2 <br />Ease/Encroach. <br />Other: <br />iropriate Item j.e <br />El Contract <br />F] Resolution <br />Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />i Proposal ❑ Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />uired Information <br />❑ PCA <br />Company or Vendor Name Martell Electric LLC <br />New Vendor ❑ Yes El No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE [ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Light UpmmmSouth Bend — Riverside Li tin <br />g ... .........._.—__ ......� <br />Project Number 118-011A <br />Funding Source COIT <br />Account No. 404.0602.43.�......3.�.....06���._.............�.w.�....��,..m,�A......................�.�.�.............�.�_.._...........�........�.... <br />u............................................�.........�.� —� �A..................................................._ <br />Amount $ <br />Terms of Contract <br />Purpose/Description Relocation of TESCO electrical service point and additional <br />tional <br />directional boring and conduit, <br />❑ Required Contractor's Certification Form Attached (Non- <br />_yCollusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Onl^ <br />Amount of ® Increase $ 7,961.20 <br />❑ Decrease $ <br />Previous Amount $ 95,228.00 <br />. Current Percent of Change: mm8.36% <br />New Amount <br />Total Percent of Change <br />Copy <br />Original <br />F <br />$ 103,189.20 <br />31% <br />Dispersal After Approval <br />