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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 5, 2018 <br />Name David Delos Department DCl <br />BPW Date February 13,20�18 Phone Extension 5836 <br />. ..... ... ..... _ . . ...... .. <br />Legal <br />Controller <br />Purchasing <br />H Attorney Name Ben Dougherty <br />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 />El <br />LJ <br />Agreement <br />LJ <br />Contract Ll Proposal Ll Addendum <br />0 <br />Professional Services <br />M <br />Resolution <br />F-1 Bid Opening <br />F1 Bid Award F] Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />F] Quote Award <br />Change Order No. <br />[:1 C/O & PCA No. F-1 PCA <br />F1 <br />Ease/Encroach. <br />D Traffic Control <br />F1 <br />Other: <br />Company or Vendor Name Redevelopment Commission <br />New Vendor El YesE:1 No E] If Yes, Approved by Purchasing <br />MBE/WBE Contractor F] MBE n WBE <br />Project Name <br />Project Number <br />Funding Source N/A <br />Account No. <br />Amount $ <br />Terms of Contract <br />Purpose/Description Transfer to the Redevelopment Commission the former PNA property at <br />2401 W Western Ave for development opportunities. <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc.) <br />Amount of F-1 increase $ <br />[:] Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />'Total Percent of Change-, <br />Dispersal After Approval <br />Copy <br />Original <br />E] D. Relos <br />R Ben Dou <br />