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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/16/16 <br />Name Toy Villa kl/ Department Engineering <br />BPW Date 007/26/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller El greater <br />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 ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ® C/O & PCA No. 1 Final ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I -I Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Required Information <br />Rieth Riley Construction Co. <br />❑ Yes ® No ❑ If Yes <br />❑ MBE ❑ WBE <br />U No ❑ Yes Name of Company <br />Ireland Road & High Street Intersection Improvements <br />115-091 <br />SSDA TIF <br />430.1050.460.31.06 <br />"n Ann nn <br />Project Closeout. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of ❑ Increase $ 171.06 <br />❑ Decrease $ <br />Previous Amount $ 239,291.00 <br />Current Percent of Change: 0.07% <br />New Amount $239,462.06 <br />Total Percent of Change: 0.07% <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />David Relos <br />Judy Love <br />Tov Villa <br />Dispersal After Approval <br />