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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/6/19 <br />Name Kyle Silveus Department En crIn <br />BPW Date 8/13/19 Phone Extension 9083 <br />irvxrmav�rr�uurrvw�em�mmm� cud mmmmmmmwmm mr�vncarauv�ummwmmmwwmmmmmm�o mum�m ni <br />IT Required Prior to Submittal to Boardm <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 ❑ <br />Check th <br />rl Agreement <br />El Professional Services <br />Bid Opening <br />❑ Quote Opening <br />® Change Order No. 1 <br />❑ Ease/Encroach. <br />El Other: <br />Company or Vendor Name <br />L� Contract <br />Resolution <br />❑ Bid Award <br />[] Quote Award <br />❑C/O &PCANo, <br />❑j Traffic Control <br />Niezgodski Plumbing, Inc. <br />)r All Sint <br />Proposal <br />❑ Req. to Advertise <br />n <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />Project Name Lafayette Buildi!I wDrain Replacement <br />Project Number 119-042A . .............................�. <br />Funding Source RWDA <br />AccountNo. 324-1050-460-42.02.......................�.�.�.�.�.�.�.�.�.�.�.�.�.�...............w.�..�..��....�.�........................�...._.�... ,�. <br />Amount $ <br />Terms of Contract <br />Purpose/Description Sub floor drains were deteriorated to the extent that the top third of the <br />metal pipe was gone. No way to tie in roof drains without having a good <br />piece of piping to attach to. Roof drain under concrete floor needed to <br />replaced <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination,. Non -Debarment, E-Verify, Iran, etc.1 <br />Amount of Increase $ 20,745.60 <br />�] .... <br />Decrease $ ......... <br />Previous Amount $ 37,1270 <br />Current Percent of Change:. 55.88% ....._. New Amount$_5.7a87.2...._W.........................ww <br />60 <br />Total Percent of Change: 55.88% <br />Dispersal After Approval <br />Copy <br />Original) <br />❑ <br />❑ <br />