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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 13, 2017 <br />Name David Relos Department DCI <br />BPW Date January 24, 2017 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 $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required forAll Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />pany or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />uired Information <br />Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />DCI Legal Services Agreement <br />RWDA TIF <br />324-1050-460-31.01 <br />$ 75,500 <br />RDC approved at their January 12 meeting. <br />TIF to pay the Legal Dept. for TIF related services. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc <br />For Change Orders On <br />Amount of U Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: _ % <br />Dispersal After Approval <br />Copy Original <br />❑ ® BPW <br />® ❑ Ben Dougherty <br />® ❑ Judy Love <br />