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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 18, 2017 <br />Name Michael Divita 144�Department DCI <br />BPW Date November 14, 2017 Phone Extension 5843 <br />Legal ❑ Attorney Name <br />Controller ❑ Controller 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 />N Agreement <br />H Contract LJ Proposal U Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />F— Other: <br />Company or Vendor Name Smart Growth America <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Safe Streets Academy <br />Project Number NIA <br />Funding Source NIA <br />Account No. NIA <br />Amount $ 0 (any associated costs to be paid through department budgets) <br />Terms of Contract <br />Purpose/Description Memorandum of Understanding regarding the City's participation in <br />the Safe Streets Academy technical assistance program <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase $ <br />❑ Decrease $ <br />Previous Amount <br />