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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE, QUEST FORM <br />Date 12/12/2017 <br />Name Amy Shirk, Senior Bud et Department <br />-Admini & Finance <br />BPW Date 12121/2017 Phone Extension 9133 <br />Required Prior to Submittal to Board <br />Legal F1 Attorney Name <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing F-1 <br />H Agreement U Contract Ll Proposal L-1 Addendum <br />C)-V) <br />0 El Professional Services Resolutio n <br />F-1 Bid Opening "513id Award ❑ Req. to Advertise ❑ Title Sheet <br />n Quote Opening ❑ Quote Award <br />F] Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. Traffic Control <br />Other: Disposals <br />Company or Vendor Name <br />New Vendor <br />El Yes El No El If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />F-1 MBE [:] WBE <br />MBENVBE Contractor Requested [:] No [:] Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For (>an <br />- 9A_g_e Orders Only <br />Amount of F-1 increase $, <br />F-1 Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change.- <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />F-1 F-1 <br />F-1 F1 <br />0 El <br />