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BOARD OF PUBLIC WORI(S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 2, 2018 Department Public Works <br />Name Roger T. Nawrot Division/Bureau Engineering <br />_BPW Date March 13, 2018 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />Legal Z Attorney Name: Clara McDaniels <br />Controller z 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 Z Michael Schmidt <br />Check the Appropriate Item Type — Required forAll Submissions <br />❑ Agreement 0: Contract El Proposal El Addendum <br />F-1 Professional Services F-1 Resolution <br />n Bid Opening n Bid Award Z Req. to Advertise )m Title Sheet <br />El Quote Opening F-1 Quote Award <br />F-1 Change Order No. El C/O & PCA No. ❑ PCA <br />n Ease/Encroach. El Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />ui red' Information <br />El Yes 0 No ❑ If Yes, Approved by <br />Purchasing <br />E] MBE E] WBE <br />El No 0 Yes Name of Company <br />Downtown Cross Streets Improvements Phase I <br />117-nAlA <br />Bids will be received on April 10, 2018. <br />E] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of El increase $ <br />El Decrease <br />P'revious Amount $ <br />Current Percent of Change: % MAP I q <br />New Amount <br />Total Percent of Change: % <br />Disr)ersal After Aonroval <br />py <br />Original <br />El <br />11 <br />F-1 <br />F1 <br />F1 <br />El <br />