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Date 9-9-2016 <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department Public Works <br />Name <br />Blair Spotts <br />Division/Bureau <br />Engineering <br />BPW Date <br />9-13-2016 <br />Phone Extension <br />5998 <br />I Required Prior to Submittal to Board <br />Legal ® Attorney Name: MS <br />Controller ❑ Controller 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. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanqe: <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Required Information <br />The Airmarking Co., Inc. <br />❑ Yes ® No ❑ If <br />Purchasing <br />MBE ❑ WBE <br />❑ No ❑ Yes Name of Comoanv <br />Jefferson Blvd Striping Phase 1 <br />116-037A <br />Engineering Professional Services <br />101-0602-431.31-06 <br />@G7 nQA nn <br />es, Approved by <br />Restriping from Eddy St to Ironwood Dr. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />