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BOARD OF PUBLIC WOICKS <br />AGENDA ITEM R1KVIEW REQUEST FOIZM <br />Date March 5, 201V <br />Name Tara Weigand <br />Department <br />Division/Bureau <br />F%11111�" 111 <br />Engineering <br />BPW Date March 13, 2018 Phone Extension 5998 <br />Required Prior to Submittal to Board <br />Legal Attorney Name: <br />Controller F] 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 n <br />Professional Services <br />F-1 Resolution <br />❑ Bid Opening n Bid Award El Req. to Advertise Title Sheet <br />❑ Quote Opening n Quote Award <br />❑ Change Order Nio, F-1 C/O & PCA No. PCA <br />Ease/Encroach. H Traffic Control:. Residential Handicap Parking <br />R Other: <br />Company or Vendor Name <br />F1 YesE] No F1 If Yes, Approved by <br />New Vendor Purchasinq_._._ <br />MBEANBE Contractor R MBE 0 WBE <br />MBENVBE Contractor Requested LJ No L] Yes Name of Company <br />Project Name Residential Handicap Parking <br />Project Number 1135 E Fox Street <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc,) <br />Required For Change Cyr Ors n1y <br />Amount of ❑ increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />Roger Nawrot, Assistant City Engineer <br />Ed Gleckler, Manager Bureau of Traffic & Lighting <br />