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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/20/2016 Department <br />Public Works <br />Name Richard Estes Division/Bureau Engineering <br />BPW Date 9/27/2016 Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <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 ® George King <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 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 />Current Percent of Chang_ <br />New Amount <br />Total Percent of Chance: <br />Increase <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />uired Information <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />Lj No LJ Yes Name of Company <br />JMS Exterior Emergency Exit Stairwell <br />116-098 <br />RWDA TIF <br />324-1050-460-3102 <br />Installation of an exterior emergency exit stairwell. Proposed <br />schedule: Ad1-9/30, Ad2-10/7, Bids Due 10/20, Bid Award 10/25 <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Patrick C Kerr <br />After <br />