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Date <br />Name <br />BPW Date <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11 /20/2017 <br />Adam Parsons <br />11 /28/2018 <br />Department <br />Division/Bureau <br />Public Works <br />Sustainability <br />Phone Extension 5910 <br />Re uired Prior to Submittal to Board <br />Legal ® Attorney Name: Catherine 1=annello <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 />❑ Agreement <br />U <br />Contract U Proposal U Addendum <br />❑ Professional Services <br />E] <br />Resolution <br />❑ Bid Opening <br />❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />® <br />Quote Award <br />❑ Change Order No. <br />❑ <br />C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control: <br />❑ <br />Other: <br />Required Information <br />Company or Vendor Name Martell Electric <br />❑ Yes ® No ® If Yes, Approved by <br />New Vendor Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBEMIBE Contractor Requested ❑ No ❑ Yes Name of Company_ <br />Project Name EV Charging Station <br />Project Number <br />Funding Source Grants and Subsidies, 222-0616-419.39.30 <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description Installation of 2 EV chargers attached to a single mounting pole <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />�a <br />p�0 <br />Dispersal After A <br />Copy Original <br />® ❑ Kara Boyles, Ph.D., P.E., City Engineer <br />® ❑ Ed Gleckler, Manager Bureau of Traffic & Lighting <br />® ❑ SBPD <br />