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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />01/13/2017 <br />Public Works <br />Engineering <br />BPW Date 01/24/2017 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 />Richard Estes <br />Department <br />Division/Bureau <br />Purchasing ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services ❑ Resolution <br />❑ <br />Bid Opening ® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening ❑ Quote Award <br />❑ <br />Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. ❑ Traffic Control: <br />❑ <br />Other: <br />Required Information <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 ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />The Lincoln Electric <br />LJ Yes LJ No lJ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Equipment Purchase for Nello Corporation Phase XVI <br />116-137 <br />River West Development TIF <br />324.1050.460.42.07 <br />,812.23 <br />Self -Supporting Tower Leg Welding Automation System <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Change Orders <br />Copy <br />Original <br />❑ <br />❑ Aaron Kobb <br />® <br />❑ Robert Rumpler (Nello Corp) <br />❑ <br />❑ <br />