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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />November 1, 2016 <br />David Relos <br />Department DCI <br />BPW Date November 8, 2016 Phone Extension 5836 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Ben Dougherty <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 j3a ')'uw <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 Redevelopment <br />Commission <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/VVBE Contractor ❑ MBE ❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount $ <br />Terms of Contract RDC to approve at their 11/10 meeting. <br />Purpose/Description To transfer the Firehouse Theatre building on Portage from BPW to the <br />RDC for redevelopment purposes. The Civic Theatre cancelled their lease <br />and has turned in the keys. <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 />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Original <br />® BPW <br />❑ Ben Dougherty <br />❑ David Relos <br />