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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW REQUEST FORM <br />Date February 5, 2018 <br />Name David Relos Department DC1 <br />BPW Date February 1.3, 2018 Phone Extension 5836 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Ben Dougherty <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing F-11 <br />H Agreement <br />F1 Contract ❑ Proposal ❑ Addendum <br />D Professional Services <br />M <br />Resolution <br />n Bid Opening <br />[J <br />Bid Award F] Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />El <br />Quote Award <br />Change Order No., <br />E] C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />7ml MOM <br />17JO19 <br />REDA TIT <br />429-1050-460-41.01 <br />If Yes, Approved by Purchasing <br />$ $13,890 (RDC approved April 13, 2017) <br />Terms of Contract Accept 18 remnant parcels from fNDOT <br />Purpose/Description To incorporate these remnants from the realigned SR 23 / Eddy St. in to <br />Fredrickson Park, existing r/w, or for development purposes. <br />[:1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of <br />Previous Amount <br />F1 increase $ <br />El Decrease $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />M <br />F1 <br />H <br />n <br />El <br />El <br />D. Relos <br />-Ben Dougherty <br />Dispersal After Approval <br />