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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />February 7, 2017 <br />David Relos <br />Department DCI <br />BPW Date February 14, 2017 Phone Extension 5836 <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 ADuroprlate Item TVDe — Reauired 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 />Required Information <br />Company or Vendor Name Redevelopment <br />Commission <br />New Vendor <br />MBEM/BE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Yes ❑ No ❑ If Yes, Approved by Purchasing <br />I MBE ❑ WBE <br />Leighton subdivision & transfer of Michigan St. Shops to RDC <br />Subject to Feb. 16 Plat Committee approval <br />To subdivide the shops from the larger parcel and transfer them to the <br />RDC. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc <br />I Required For Chanqe Orders OnIV I <br />Amount of <br />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 />® ❑ David Relos <br />