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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />1 /3/2017 Department <br />Richard Estes <br />Public Works <br />Division/Bureau Engineering <br />BPW Date 1/5/2017 Phone Extension 5896 <br />�! Required Prior to Submittal to Board <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 />Check the Appropriate Item Tvne — Required for All Suhmiccinn.c <br />Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Contract <br />Resolution <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control: <br />Other: Reject Bids and Re -Advertise <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 <br />Increase <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of <br />Copy <br />Origin <br />❑ <br />❑ <br />Aaron Kobb <br />® Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />Purchasing <br />EJ -MBE WBE <br />❑ No ❑ Yes Name of Com anv <br />11 <br />RWDA TIF <br />324-1050-460-3102 <br />JMS Building Fagade renovation. Proposed schedule: Ad1-1/6, <br />Ad2-1/13, Bids Due 1/24, Bid Award 1/24 <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />