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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11 /02/2017 <br />Eric Horvath <br />Department Public Works <br />BPW Date 11/14/2017 Phone Extension <br />N <br />Agreement <br />U Contract L Proposal <br />LJ Addendum <br />❑ <br />Professional Services <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ <br />Chg Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control ❑ Resolution <br />❑ Other: <br />❑ Claim <br />Required Information <br />Company or Vendor Name <br />Kroger Gardis & Regas, LLP <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ <br />No <br />MBEIWBE Contractor <br />El MBE Completed E-Verify Form Attached <br />❑ WBE <br />❑Yes <br />❑ <br />No <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />$10,000 for Testimony Preparation plus 37.3% of GDS and Umbaugh <br />Fees upon Acceptance of Testimony Adoption <br />