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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/19/2018 <br />Name Lauren Trapp Department Utilities <br />BPW Date 3/27/2018 Phone Extension 5852 <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />H Agreement <br />L 1 Contract <br />LJ Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Amendment <br />❑ <br />Bid Opening <br />❑ <br />Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Chg Order No. <br />❑ CIO & PCA No. <br />❑ <br />PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ <br />Resolution <br />® <br />Other: Industrial <br />❑ Claim <br />Discharge Permit <br />Renewals for: McCormick <br />& Co. Inc, Monarch <br />Textile Rental on <br />Lincoinway West, <br />Monarch Texile Rental on <br />Foundation Drive and <br />Unifrax 'I LLC <br />Re <br />uired" nforrnation <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />❑ Yes ❑ if Yes, Approved by Purchasing <br />❑ No <br />❑❑ WBE Completed E-Verify Form Attached ❑Nos <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />