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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />December 16, 2016 <br />Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 22, 2016 Phone Extension 5933 <br />Legal LJ Attorney Name: <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 />U Agreement LJ Contract LJ Proposal LJ 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 />R Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of LJ Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of <br />❑ Yes ® No ❑ If Yes, Approved by <br />LJ MBE LJ WBE <br />I-1 No F 1 Yes Name of Companv <br />Portageway Drive Handicap Parking <br />TR16-146 <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />py Original <br />® ❑ Roger Nawrot, Assistant City Engineer <br />® ❑ Ed Gleckler, Manager Bureau of Traffic & Lighting <br />® ❑ SBPD <br />