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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/17/2016 <br />Name <br />Ed Gleckler <br />Department <br />Traffic & Lighting <br />BPW Date <br />10/25/201.6 <br />Phone Extension <br />6001 <br />Legal Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />U Agreement <br />►J Contract U Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />® Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name All Phase Electric <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />J Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />LED Street Lights <br />Replacement LED Luminaires <br />COIT <br />404-0602-431.22-40 <br />$ 700.00 ea @ Unit Pricing - NTE $35,000.00 <br />Purchase Order- Cash Purchase <br />LED Street Lights - replace high-pressure sodium lights at various <br />locations <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <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 />® <br />❑ <br />® <br />❑ <br />❑ <br />11 <br />Ed Gleckler <br />Terri Swift <br />Dispersal After Approval <br />