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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />02-21-17 <br />Goben <br />Department SBPD <br />BPW Date 2-28-17 Phone Extension 7520 <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 />Purchasing ❑ <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Other: <br />Contract <br />Resolution0 UI <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control <br />Company or Vendor Name <br />New Vendor ❑ Yes ❑ No <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />Proposal Ll Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />FMIM <br />If Yes, Approved by Purchasing <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Retirement gift of firearm to Ronald Johnson <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />property no longer useful to the city. Serial No HKB3768.This declaration <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />Goben <br />Required Contractor's Certification Form Attached (Non - <br />Dispersal After Approval <br />