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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/6/16 <br />Name John Martinez <br />Department Venues, Parks, & <br />Arts <br />BPW Date 12/13/16 Phone Extension 235-7645 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ® George King <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />mate Item <br />Contract <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No <br />❑ Traffic Control <br />— fcequwrea rorHu 5uomissioi <br />[�fP Proposal �JRx7 <br />❑ Req. to Advertise <br />❑ PCA <br />❑ Resolution <br />❑ Claim <br />Addendum <br />❑ Title Sheet <br />TBD Final decision will be known prior to 12/7 <br />❑ Yes Ys,Aroved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />VPA: Waste Management & Recycling Services <br />Various- Morris, Parks, Century Center <br />Various <br />Waste Management Services <br />Amount of H Increase <br />$ <br />❑ Decrease <br />$ <br />Previous Amount $ <br />Current Percent of Change: <br />% <br />New Amount $ <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />