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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />03/08/2017 <br />Michael Schmidt <br />Department Legal <br />BPW Date 03/14/2017 Phone Extension <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />01➢ <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Contract <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />No <br />MBE <br />WBE <br />dF walk <br />Proposal <br />❑ Req. to Advertise <br />PCA <br />Resolution <br />Claim <br />If Yes, Approved by Purchasing <br />Addendum <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />��7sblcs�rfocc urc dr <br />a'- 4&re- POka5an <br />Amount of " Increase <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />