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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 7, 2017 <br />Tara Weigand <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date March 14, 2017 Phone Extension 5998 <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 ® George King <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />❑ <br />Agreement Amendment ® <br />Contract ❑ Proposal ❑ Addendum <br />® <br />Professional Services ❑ <br />Resolution <br />❑ <br />Bid Opening ❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening ❑ <br />Quote Award <br />❑ <br />Change Order No. ❑ <br />C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. ❑ <br />Traffic Control: <br />❑ <br />Other: <br />Required Information <br />Company or Vendor Name <br />EPOCH Architecture + Plannir <br />Yes <br />New Vendor Purch <br />MBE/WBE Contractor ❑ ME <br />MBE/WBE Contractor Requested <br />Project Name Centu <br />Project Number 117-0 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Hotel -Motel <br />No <br />7304.42010.000.0099 <br />$14,760 <br />of <br />Yes, Approved by <br />Restoration <br />Repair of masonry on the exterior of the Century Center (Phase <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Orders On <br />® ❑ Kara M. Boyles <br />® ❑ EPOCH Architecture + Planning (Kyle Copelin) <br />® ❑ Scott Herczeg, Leanna Belew <br />