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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/7/17 <br />Name <br />Toy Villa <br />Department <br />Engineering <br />BPW Date <br />02/17/17 <br />Phone Extension <br />5920 <br />Legal ❑ Attorney Name <br />Controller El greater <br />review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ® C/O & PCA No. 1 Final ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Required Information <br />Acorn Landscaping LLC <br />❑ Yes ® No ❑ If Yes, Approved by Pu <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />2016 Downspout Disconnect Program <br />115-098 <br />Funding Source <br />Wastewater Other Contractuals <br />Account No. <br />641.0630.793.63.35 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />® <br />Decrease $ 39,294.80 <br />Previous Amount <br />$ 48,355.00 <br />Current Percent of Change: <br />81.26% <br />New Amount <br />$ 9,060.20 <br />Total Percent of Change: <br />81.26% <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />