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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 20, 2016 <br />Name David Relos Department DCI <br />BPW Date September 27, 2016 Phone Extension 5836 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Ben Dougherty <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 />L 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 />Required Information <br />Company or Vendor Name Redevelopment Commission & Parks Dept. <br />New Vendor <br />MBE/WBE Contractor <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 />Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />RDC approved transfer and Assignment / Assumption on Sept. 15 <br />Resolution 44-2016: BPW accepting the transfer of the Wayne St. Garage <br />and the Assignment and Assumption of Garage Related Agreements from <br />the RDC and Agency Agreement delegating parking garage management <br />duties to the Parks Dept. <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 />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />0 <br />® <br />❑ <br />® <br />❑ <br />BPW & Parks <br />Ben Dougherty <br />David Relos <br />Dispersal After Approval <br />