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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/21/2018 Department Fire <br />BPW Date 3/13/2018 Phone 9255 <br />Name Stephen Cox, Fire Chief <br />0 Legal ❑ Attorney Name <br />0—Controller review is required for all Contracts $5,000.00 or more <br />.5 <br />0 Controller ❑ and greater than one year in length per the City Purchasing <br />O_ Policy <br />U) Purchasing F-1 <br />Check the A propriate Item Type — Required for AH Submissioos <br />A�em_ert <br />0 Contract Ll Proposal en urn <br />El <br />Claim <br />❑ <br />Bid Opening <br />E] Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />[j <br />Quote Opening <br />—Quote Award <br />E] <br />Chg Order No. <br />❑ C/O & PCA No. El PCA <br />F1 <br />Ease./Encroach. <br />El Traffic Control <br />Resolution <br />El <br />Other: <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />El If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Disposal of Unfit Property-, retirees..: M. Killelea, M. Steele, D. <br />Okrezik <br />For Change Orders Only <br />Amount of F] increase <br />� <br />[:1 Decrease <br />Previous Amount $ <br />Current Percent of'Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Copy <br />Original <br />F-1 <br />Dispersal After Approval <br />