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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 216118 <br />Name Brian Donoahue <br />Department Innovation & Tech <br />BPW Date 2/13/18 Phone Extension 5816 <br />Z <br />Agreement <br />U Contract <br />U Proposal U Addendum <br />❑ <br />Professional Services <br />❑ <br />Amendment <br />❑ <br />Bid Opening <br />❑ <br />Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ <br />Chg Order No. <br />❑ CIO & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />n <br />Other: <br />❑ Claim <br />Company or Vendor Name RoadBotics, Inc. <br />New Vendor N Yes U If Yes, Approved by Purchasing <br />I-1 No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify .Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Project Name Street Condition Assessment Pilot Project <br />Project Number <br />Funding Source <br />Account No. <br />Streets <br />Amount $5,000 <br />Terms of Contract Pilot project with RoadBotics to develop a rating of pavement <br />condition using video technology in a small geography within the <br />Purpose/Description <br />Amount of H Increase <br />❑ Decrease <br />$ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />