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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />01/20/2018 <br />Department <br />Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />02/13/2018 <br />Phone Extension <br />5920 <br />om <br />Controller <br />Purchasing <br />L_J Agreement <br />F-1 Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />F Change Order No. <br />F1 Ease/Encroach. <br />F-1 Other: <br />New Vendor <br />MBE/WBE Contractor <br />n Attorney Name: <br />E] Controller review is required for all Contracts $5,0010.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />El <br />I I Contract <br />N <br />FS M TIM <br />n Bid Award E:1 Req. to Advertise <br />Quote Award <br />C/O & PCA No. PCA <br />Traffic Control: <br />Required Information <br />TGB Unlimited (dba) S/T Bancroft Electric <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Addendum <br />El Title Sheet <br />U Yes M No H If Yes, Approved by <br />Purchasing <br />LJ MBE LJ WBE <br />El No El Yes Name of Company <br />River Walk Lighting <br />117-080 <br />COIT <br />404.0602.431.22A0 <br />$47,990.00 <br />ect Closeout <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of F-11 increase $ <br />D Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />11 <br />El <br />F-1 <br />F-1 <br />n <br />El <br />