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BOARD OF PUBLIC WORKS <br />AGENDA ITEM IaWIEW REQUEST FORM <br />HIMM. <br />Sue Ellen Doudrick <br />Department Department of PW <br />Division/Bureau Engineering <br />BPW Date 1-23-2018 Phone Extension 5922 <br />Legal 0 Attorney Name: Clara McDani'els <br />Controller E] 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 Michael Schmidt <br />L Agreement Amendment H Contract L Proposal H Addendum <br />F] Professional Services D Resolution <br />R Bid Opening F-1 Bid Award El Req. to Advertise ❑ Title Sheet <br />F-1 Quote Opening ❑ Quote Award <br />0 Change Order No. ❑ C/O & PCA No. F] PCA <br />F] Ease/Encroach. Traffic Control. Long Term Occupancy Request <br />F-1 Other: <br />New Vendor <br />MBEANBE 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 ❑ <br />Kite Realty <br />El Yes N No, F1 If Yes, Approved by <br />Purchasing <br />[:] MBE [:] WBE <br />El No El Yes Name of Company <br />Eddy Street Commons Phase 11 <br />DP17-005 <br />n/a <br />n/a <br />n/a <br />n/a <br />Long Term Occupancy Request for Eddy Street - <br />see attachments for locations of closure and correspondence <br />with adjacent residents. <br />F1 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 />Original <br />F-1 <br />F-1 <br />F-1 <br />❑ <br />El <br />El <br />