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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/16/19 Department Public Works <br />KyleS. Name K ry.......................................wm <br />y veus Division/Bureau Engineering <br />BPW Date 4/23/19............ <br />_.........................._�.....................................�_�. �..........�....... Phone Extension �90�8�3...............�................ <br />��� ��.. <br />�..-w .._...... _ Required Prior to Submittal Wto Board <br />Legal E] Attorney Name: Clara McDaniels <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 ( Michael Schmidt <br />Check the <br />E] Agreement Amendment <br />Professional Services <br />[� Bid Opening <br />Quote Opening <br />® Change Order No. 1 <br />❑ Ease/Encroach. <br />Other: <br />Top ate Item Ty - <br />I Contract <br />❑ Resolution <br />❑ Bid Award <br />El Quote Award <br />❑ C/O &PCANo. <br />_ <br />❑ Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />for All Submissions <br />I Proposal <br />E] Req. to Advertise <br />Reauired Information <br />PCA <br />Addendum <br />❑ Title Sheet <br />Project Name <br />Gemini Washington -Colfax Masonrin„d Stair Repairs <br />_ _�.�. <br />Project Number <br />118-080B <br />Funding Source <br />West Washington TIF <br />Account No. <br />422-1050-460-42.02 <br />Amount <br />Division B: $168,844.00 <br />Terms of Contract <br />Lump Sum <br />Purpose/Description <br />Re lacement of concrete stair fdotNn s <br />F] Required Contractors Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders mm...�.....mm <br />Amount off Increase $ 17,595 m <br />M Decrease J <br />Previous Amount <br />$ 168,844 <br />Current Percent of Change: <br />- —-------- .............................�.�.�..... �.. ..... � �......m.................................� _�................�6. m, ............... .. <br />10.42o /o <br />New Amount <br />......... ....................--- ........_. _ --- � � �� _�.......... .r ___ �...�.�...................._ <br />$ 186,439 <br />Total Percent of Change <br />10.42% <br />Dispersal After Approval <br />Copy <br />Original <br />F1 <br />El <br />❑ <br />El <br />❑ <br />❑ <br />