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BOARD, OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 18, 2017 Department Public Works <br />Name Tara Weigand Division/Bureau Engineering <br />BPW Date December 2,1, 2017 Phone Extension 5998 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: <br />Controller El 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 R <br />LJ <br />Agreement Amendment <br />H Contract <br />H Proposal Addendum <br />El <br />Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />F-1 Bid Award <br />0 Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />F-1 Quote Award <br />R Change Order No. <br />El <br />C/O & PCA No. <br />El PCA <br />EJ <br />Ease/Encroach. <br />Traffic Control: <br />Residential Handicap Parking <br />R <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />El Yes El No F-1 If Yes, Approved by <br />Purchasina <br />Ll MBE Ll WBE <br />n No ❑I Yes Name Of Company <br />137 Sadie Street Residential Handicap Parkina <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy Original <br />Roger Nawrot, Assistant City Engineer <br />Ed Gleckler, Manager Bureau of Traffic & Lighting <br />F-1 SBPD <br />