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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />8/14/17 <br />Matt Chlebowski <br />Professional Services <br />Bid Opening <br />E] Quote Opening <br />El Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of F� <br />n <br />Resolution,N),, <br />Bid Award <br />Quote Award <br />El C/O & PCA No. <br />n Traffic Control <br />Department Central Services <br />F� Req. to Advertise <br />FEME <br />0 Title Sheet <br />_LJ Yes LJ No LJ If Yes, Approved by Purchasing <br />F] MBE n WBE <br />0 No 0 Yes Name of Company <br />Obsolete Auction Items <br />1p, <br />Declaring the attached list of equipment obsolete. <br />n Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discrim i nation, Non -Debarment, E-Verifv, Iran, etc. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change. - <br />Copy <br />Original <br />F-1 <br />F-1 <br />Dispersal After Approval <br />Matt Chlebowski & Sheila Enos <br />