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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11 /07/17 <br />Dan Buckenmeyer Department <br />DCI <br />BPW Date 11/14/17 Phone Extension X5823 <br />Legal ® Attorney Name Ben Dougherty <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 />H Agreement <br />U Contract <br />L] Proposal <br />H Addendum <br />® <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise <br />❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ <br />CIO & PCA No. <br />❑ PCA <br />❑ Ease/Encroach. <br />❑ <br />Traffic Control <br />❑ Other: <br />f '. 'R <br />u��red Iraformat�on , , - f <br />r <br />Company or Vendor Name West.SB LLC. <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 />Proiect Name Professional Services — Advertising - Workforce Development <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />COIT <br />408,1001.460.31.06 <br />$500 <br />e Mayor's Pathways Workforce Program <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc. <br />Amount of U Increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />N <br />