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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE VIEW REi QUEST FORM <br />Date <br />Name <br />March 19, 2018 <br />David Relos <br />March 27, 2018 <br />Department DC1 <br />Phone Extension 5836 <br />Required Prior to Submittal to Board <br />Legal Attorney Name Elliot Anderson <br />Controller El Controller review is required for ail Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />M Agreement <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />F-1 Change Order No. <br />El Ease/Encroach. <br />] Other: <br />Company or Vendor Name <br />H Contract <br />F1 Resolution <br />F-1 Bid Award <br />n Quote Award <br />F1 C/O & PCA No. <br />El Traffic Control <br />Kit Architecture Planning <br />Ll Proposal H Addendum <br />E] Req. to Advertise E] Title Sheet <br />10:1=11 <br />New Vendor El Yes E] No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE F-1 WBE <br />Project Name Lafayette Building Reroof <br />Project Number <br />Funding Source RWDA <br />Account No. 324-1050-460-31.06 <br />Amount $ 10,000 not to exceed <br />Terms of Contract Hourly basis; to be paid from RDC approved budget. <br />Purpose/Description To provide structural engineering services for removal / repair of damaged <br />roof joists once the current roof is removed, <br />[:1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Qrlly___ <br />Amount of El increase $ <br />F-1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />David Relos <br />E] Judy Love <br />