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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/16/19 <br />e Silveus <br />Department Engineering <br />BPW Date 12/19/19 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name Clara McDaniels <br />Controller F-1 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 D Michael Schmidt <br />Check the <br />❑ Agreement <br />❑ Professional Services <br />F-1 Bid Opening <br />El Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />F-1 Other: <br />iropdato Item Type <br />R Contract <br />❑ Resolution <br />® Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />_ <br />❑ Traffic Control <br />for All Submissions <br />.......... <br />➢ Proposal R Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />ftaquired Information <br />Company or Vendor Name Walsh and Kelly, Inc. <br />❑ PCA <br />New Vendor <br />EJ Yes Z No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />EJ MBE [] WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Two -Way ConversionofmColfax Ave. — Phase II <br />Project Number <br />115-053B <br />Funding Source <br />River West DevelwopmwentwwArea TIFmmm <br />Account No. <br />324-1050-460.42-01 <br />Amount <br />$594,900 <br />Terms of Contract <br />Base Bid <br />Purpose/Description <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of 0 Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change; <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F <br />❑ <br />❑ <br />. .. <br />Dispersal After Approval <br />