Request to Advertise - Miami Basin Valve Replacement Project No 116-082D

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date November 4, 2019 Name Roger T. Nawrot Department Public Works Division/Bureau Engineering BPW Date November 11, 2019 Phone Extension 5932 mmmm�mmmoom� � a __ R�quired Prior to Submittal to Board Legal ❑] Attorney Name: Controller Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing El Check the [_J Agreement [l Professional Services ❑ Bid Opening El Quote Opening [] Change Order No. _ Ease/Encroach. Other: Company or Vendor Name Y Contract ❑ Proposal nWT� eyebmissions [] Resolution [l Bid Award ® Req. to Advertise R Quote Award ❑ C/O & PCA No. ❑ PCA Traffic Control: New Vendor MBE/WBE Contractor MBE/WBE Contractor Requested Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description uired Information Addendum ® Title Sheet ❑ Yes ® No ❑ If Yes, Approved by Purchasing ❑ MBE [❑' W..........��....... ........... _.......�..��_��_�.....�__..� .��.�. _._ .....m_� B E ��.... ...... wm No 0 Yes Name of Company Miami Basin Valve Replacement 116-082 D SewerFund and South Side TIF 226-0419-672.42-03 430-1050-460.42-01 _.�...._�.........___��...w " Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) equiired For Change Orders Only Amount of Increase w$w ................ w ❑ Decrease $ Previous Amount $ Current Percent of Change: w % New Amount $ _. .-..... ......... Total Percent of ange ... _............. ....... ___ % Dispersal After Accroval Copy Original ❑ IE] ❑ El