Change Order No 4 - LWW and Charles Martin Sr Drive Improvements Project No 117-072A - Selge Construction

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 04/30/2019 Name Kyle Silveus Department Engineering —.. ................ BPW Date 05/14/2019 Phone Extension 9083 �a arrrmmmmaAmmmmmmmmmmmmmmmmuuuuuuuuuuuuuuuuuuuuuuuuuuuuumuuuuuuuuuummmmmuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuum�wnmrmrrrrrrrrrnnnm�!vraumi a mm mn✓en ..... . _ ........... ...... ......... Required Prior to Submittal to Board _.......... Legal ❑ Attorney Name Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the ❑' Agreement El Professional Services E:1 Bid Opening ❑ Quote Opening ® Change Order No. 4 ❑ Ease/Encroach. Other: Nropriate Item T p El Contract El Resolution El Bid Award Quote Award [C/O &PCANo. [� Traffic Control :.or All Submissions .. ___._._....... � ......._. 9 Proposal [ ] Addendum F] Req. to Advertise ❑ Title Sheet fired Information ❑ PCA Company or Vendor Name Sel e Construction Co. Inc. New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing MBE/WBE Contractor ❑ MBE ❑ WBE MBEM/BE Contractor Requested ❑ No ❑ Yes Name of Company i ectioprovemen Project Name LWW Charles .,Mart.'nntersn Improvements Intersection � . �,....� Project Number 117-072A Funding Source RWDA Account No. 324.1050.460.42.03................................................................ Amount $ Terms of Contract Purpose/Description Acid WUB S Pavan & Strj inW WW ❑ Required Contractor's Certification Form Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. uired For Chanon Orders On Amount of Z Increase $ 3,260.07 [ Decrease $ Previous Amount $�1'195,263 03 ..........................................�.�.�.�.......... __ ......� Current Percent of Change:. 0.27% New Amount $1,1987523.10 Total Percent of Change: 5.97% Dispersal After Approval Copy Original ❑ F1 ❑ E] El E]