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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Sep. 21, 2016 Department Engineering <br />Name Richard Estes Division/Bureau Public Works <br />BPW Date Sep 27, 2016 Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <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 />n 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 />Amount of <br />Previous Amount <br />red Information <br />❑ No ❑ Yes Name of Company <br />2016 Parking Garage Improvements <br />115-143 <br />Parking Garage Fund <br />412-0401-415-36.01 <br />Attempt to Re -bid Elevator Repairs and Structural Repairs as - <br />needed <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />ired For Change Orders <br />Increase <br />Decrease $ APPROVED <br />g of PalicWorks- <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ Corbitt Kerr <br />® <br />❑ David Relos <br />® <br />❑ John Martinez <br />Dispersal After <br />