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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/19/2018 <br />Name Lauren Tr; <br />Department Utilities <br />BPW Date 3/27/2018 Phone Extension 5852 <br />Legal <br />Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ <br />and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate Item Ty e Required for All Submissrons' <br />❑ Agreement <br />0 Contract L] Proposal <br />❑ Addendum <br />❑ Professional Services <br />❑ Amendment <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ <br />CIO & PCA No. <br />❑ <br />PCA <br />❑ Ease./Encroach. <br />❑ <br />Traffic Control <br />❑ <br />Resolution <br />® Other: Industrial <br />❑ <br />Claim <br />Discharge_ Permit <br />Renewals for: McCormick <br />& Co. Inc, Monarch <br />Textile Rental on <br />Lincolnway West, <br />Monarch Texiile Rental on <br />Foundation Drive, and <br />Unifrax 'I LLC <br />Re `uired''lnformatioi:, <br />Company or Vendor Name <br />New Vendor <br />❑ <br />Yes ❑ if Yes, Approved by Purchasing <br />❑ <br />No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached <br />ElNeos <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Time Extension: <br />