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BOARD OF PUBLIC WORDS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 19, 2017 Department Public Works <br />Name Tara Weigand Division/Bureau Engineering <br />BPW Date December 21, 2017 Phone Extension 5998 <br />Legal Z Attorney Name: <br />Controller z 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 z <br />R Agreement Amendment <br />0 Contract LJ Proposal H Addendum <br />F1 Professional Services <br />F1 Resolution <br />Bid Opening <br />0 Bid Award E] Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />Quote Award <br />F1 <br />Change Order No. <br />C/O & PCA No. ❑ PCA <br />Ease/Encroach. <br />D <br />Traffic Control: <br />Other., <br />Company or Vendor Name <br />New Vendor <br />MBEA/VBE Contractor <br />MBEANBE Contractor 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-1 <br />R <br />Pemberton Davis Electric, LLC. <br />El Yes 0 No F1 If Yes, Approved by <br />Purchasing <br />MBE [:] WBE <br />[:]No[:]Yes Name ofCompany_ <br />FUR Traffic Cameras <br />117-122 <br />LRSA - Traffic Signal Maintenance <br />251-0608-431.36-67 <br />$104,920.00 <br />Unit Prices - Divisions A, B, and C <br />Install FUR traffic cameras at four intersections in the city <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, 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 />Roger Nawrot, Assistant City Engineer <br />Ed Gleckler, Manager Bureau of Traffic & Lighting <br />Derick Roberts, Streets Department <br />Original <br />❑ <br />�E] <br />❑ <br />