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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/02/2018 <br />Department VPA: Facifities, & <br />Name Patrick Sherman Grounds <br />BPW Date 01/09/2018 Phone Extension 5601 <br />. ... . ....... <br />Reg d <br />qi�e Submittal to, Boar 4 Prior to Subm <br />Legal Z Attorney -Name Dani Campbell <br />Controller Controller review is required for all Contracts $5,000.100 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Z Michael Schmidt <br />Agreement <br />Professional Services <br />" Contract <br />F-1 Resolution <br />Proposal <br />Addendum <br />Fj Bid Opening El Bid Award Z Req. to Advertise ❑ Title Sheet <br />n Quote Opening El Quote Award <br />Change Order No. <br />Ease/Encroach. <br />F-1 C/O & PCA No. <br />n Traffic Gontr6l <br />Company or Vendor Name TBD <br />New Vendor E:1 Yes El No 0 If Yes, Approved by Purchasi <br />MBENVBE Contractor [:] MBE []WBE <br />MBEANBE Contractor Requested F-1 No F-1 Yes Name of CorTipany <br />Project Name <br />Electrical Services Contract <br />Project Number <br />1040-2018, <br />Funding Source <br />K61 RMT <br />Account No. <br />201-1101-452 36.01 <br />Amount $ TBD <br />Terms of Contract Contract details to be negotiated after RFP selection process <br />Purpose/Description Electrical services contract for VPA <br />M Required Contractor's Certification Form Attached (Non <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Reqq!red For Chang Orders Ohl. <br />Amount of F-1 increase $ <br />n Decrease $ <br />ApPROm <br />Previous Amount $ VI <br />Current Percent of Change:% VuMik, vi".). <br />New Amount <br />Total Percent of Chan <br />Copy <br />Original <br />F] <br />El <br />F] <br />n <br />❑ <br />El <br />