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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />7/31/2017 <br />Christina Brooks <br />Department Mayor/AdmFin <br />BPW Date Phone Extension <br />Legal <br />Attorney Name Michael Schmidt <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ <br />and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type - Required f&AIISubmissions.:� <br />Agreement <br />❑ g <br />El ❑ Proposal <br />....:....--- <br />❑ Addendum <br />® Professional Services <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control ❑ Resolution <br />❑ Other: <br />❑ Claim <br />Required lnformation <br />Company or Vendor Name <br />Prosperity Now <br />® Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBEIWBE Contractor <br />MBE Completed E-Verify Form Attached. <br />❑ WBE - _ _ <br />❑Yes <br />❑ No <br />Project Name <br />Prosperity Now!: Partnership for Inclusive Economy <br />Project Number <br />Funding Source <br />DCI- previous funding source ` J1 <br />Account No. <br />�l(. l out, uG©. 31, nL <br />Amount <br />$16,000 <br />Terms of Contract <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />