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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE QUEST FORM <br />Date February 20, 2018 <br />..- ........... <br />Name David Relos, Department _DC1 <br />BPW Date February 13, 20127 Phone Extension 583,6 <br />------- --- - . .... .. ........ <br />Required Prior to Submittal to Board <br />Legal Z 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 El <br />Check <br />❑ Agreement <br />F-1 Professional Services <br />El Bid Opening <br />F-1 Quote Opening <br />R Change Order No. <br />F-1 Ease/Encroach. <br />F-1 Other: <br />LJ Contract <br />i <br />Z Resolution 2o /� <br />F-1 Bid Award <br />F-1 Quote Award <br />[J C/O & PCA No. <br />El Traffic Control <br />)rAll -mmissions <br />Proposal El Addendum <br />Ej Req. to Advertise EJ Title Sheet <br />Reauired Information <br />am <br />Company or Vendor Name Redevelopment Commission <br />New Vendor F] Yes El No F-1 If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 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 Lafayette building at 115 <br />S. Lafayette for development opportunities, <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.),_ <br />Required For Change Orders Only <br />Amount of increase $ ... . .... . ... <br />F] Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />F1 D. Relos <br />❑ Ben Dougherty <br />El F] <br />