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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/27/2019 Department Public Works <br />............ �.......... <br />Name To Villa �...���. �� ....... �..........._.... ��--- Division/Bureau Engineering .�. ....._��� <br />BPW Date 04/09........­01m..........-_............................ _............. ..�.._.�.� <br />/2 9 Phone Extension 5920 <br />mmmrewmmmm 000mmmw�mwooamm•,mmnmmmnmoonnnmmmmm w mnaawmmmumuuuuuuuuuuwuwuw�wmuwmmmmwwwrrmm mm <br />..m........._�,. �,�,�,�,�,�,..__ ......... ..... .. .�.......... <br />wwww� Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the <br />LJ Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. 5 <br />El Ease/Encroach. <br />F Other: <br />Company or Vendor Name <br />L Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />C/O & PCA No. <br />❑ Traffic Control: <br />—_Required for All Submissions <br />Proposal <br />0 Req. to Advertise <br />ired Information <br />❑ PCA <br />Larson Danielson Construction Companv. Inc. <br />Addendum <br />❑ Title Sheet <br />New Vendor L__I Yes N No LJ If Yes Approved by Purchasinct <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />...._._._._._._ _ ............... <br />MBE/WBE Contractor Requested ....._w.......�. <br />q �I No Yes Name of Company <br />Howard Park Redevelopment & St. Louis Boulevard <br />Project Name Improvements <br />Project Number 117-047B <br />Funding Source Park Bond, RETIF, Regional Cities &mCum <br />ulative Capital <br />452-1101-452.02&452.03, 429-1050-460.42-02, 201-1111- <br />Account No. 452.42-01, 407-1101-452.4201 <br />Amount$ .........._...._...�.mmwm�Y ..............._ <br />Terms of Contract <br />Purpose/Description Approval of C.O. #5 <br />❑ Required Contractor's Certification Forms Attached (Non- <br />ITITITITIT _ _._ Non -Debarment, E-Verify, <br />m_ ............. .......... Collusion, Non -Discrimination, Iran, etc. <br />m mm IT& y red For Change Orders Only! <br />Amount of ® Increase $ 52,389.78 <br />❑ Decrease $ <br />Previous Amount $ 17,855,53 9.44 <br />Current Percent of Change: 0.29% _ <br />. <br />NewAmount $ 17,907,929.22......������....................,,,. .��........�.�.�.�.�.�................................................�......�.�.�.�.�.�.� <br />�_.. _ ... <br />�. Change: -4.84% <br />Total Percent of Chammm� _....mm..... _.���.�� .�...� ._...� �_._��...._ <br />Dispersal After Aeoroval <br />Copy <br />Original <br />0 <br />