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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/21/17 <br />Department <br />Name Chris Dressel <br />Community <br />Investment <br />BPW Date 3/28/17 Phone Extension 5847 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller El greater <br />review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />I-1 Other: <br />Required Information 000010 <br />Company or Vendor Name <br />Weaver Consultants Group�j-I <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEM/BE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Ground Water Monitoring Well Abandonment <br />Project Number <br />Funding Source <br />-ro S�J P bakar bh va % rooks <br />Account No. <br />209.1401.460.31.02 <br />Amount <br />$ 3,500 <br />Terms of Contract <br />Purpose/Description <br />on 9 for er <br />Seal nd aba groundwater monitoring wells. <br />6,-� �r -,r pa m <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 ❑ Increase <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />N/A <br />New Amount <br />N/A <br />Total Percent of Change: <br />N/A <br />Dispersal After Approval <br />Copy Original <br />❑ ® DCI — Chris Dressel <br />❑ ❑ <br />❑ 0 <br />