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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 $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />Other: <br />I Required Information <br />Company or Vendor Name Redevelopment <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />J Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />DCI Supervisory Services Agreement <br />RWDA TIF <br />324-1050-460-31 <br />$ 86,700 <br />RDC approved at their January 12 meeting. <br />TIF to pay a portion of the DCI Asst. Executive Director and Director II <br />Economic Resources salaries for supervisory services. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran, etc <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />BP W <br />Ben Doug. <br />Judy Love <br />r Change Orders <br />Dispersal After <br />