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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/26/18 <br />Name Michelle Smith Department Utilities <br />BPW (Date 2/13/18 Phone Extension 5994 <br />_Required Prior to Submittal to Board <br />Legal X Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000,00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing P <br />H Agreement <br />H Contract <br />LJ Proposal LJ Addendum <br />El Professional Services <br />F-1 Amendment <br />R Bid Opening <br />R Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />R Quote Opening <br />El Quote Award <br />[J <br />Chg Order No. <br />R C/O & PCA No. <br />E] <br />PCA <br />El <br />Ease./Encroach. <br />F] Traffic Control <br />El <br />Resolution <br />R <br />Other- <br />R <br />Claim <br />Company or Vendor Name <br />New Vendor <br />ZA NOTWITMITA ro reT R M = <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />US Department of the Interior/US Geological S <br />Yes ❑ if Yes, Approved by Purchasing <br />No <br />M, BBE E [:] Completed E-Verify Form Attached F1 YeNos <br />W <br />Joint Funding Agreement for Water Resource Investigations <br />NFOOGWQ <br />Water Works Operational Fund <br />6201.0640.658.31.35 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Annual agreement for water Revel measurement and analysis <br />For Change Orders Only <br />Amount of <br />. ...... <br />increase $ . ...... . . <br />Decrease <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval' <br />Copy Original <br />El M <br />Paul Buszka <br />EJ <br />. .... . . ........... . <br />Roxanne Lawson <br />F] <br />Michelle Smith <br />