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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/14/16 <br />Department <br />Name Aaron Kobb <br />Community <br />Investment <br />BPW Date 11/22/16 Phone Extension 5823 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Ben Dougherty <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract <br />❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ <br />Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />® <br />Other: Lease Renewal <br />❑ Claim <br />Company or \ <br />New Vendor <br />Required <br />Name Bruno's Pizza (T <br />MBE/WBE Contractor <br />j 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 />Yes <br />No <br />MBE <br />WBE <br />If Yes, <br />by Purchasing <br />Completed E-Verify Form Attached <br />❑ Yes <br />❑ No <br />Lease renewal between landlord and tenant for the space located <br />in the Michigan Street Shops 131 South Michigan St <br />For Change Orders Only <br />Increase $ <br />Decrease $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: Di <br />spersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />Aaron Kobb (2 Originals) <br />