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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />M <br />Denise Zialer <br />Department Morris PAC <br />BPW Date Phone Extension 5901 <br />Required Prior to Submittal to Board; <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Q and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing El <br />Check the Appropriate Item Type — Required for All Submissions <br />F-1 Agreement <br />F] Contract El Proposal F-1 Addendum <br />❑ Professional Services <br />EJ Amendment <br />❑ Bid Opening <br />El Bid Award Req. to Advertise Title Sheet <br />❑ Quote Opening <br />F-1 Quote Award <br />❑ Chg Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease,/Encroach. <br />❑ Traffic Control E] Resolution <br />El Other: <br />E] Claim <br />Required. Information <br />Company or Vendor Name <br />El Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />n No <br />MBE/WBE Contractor <br />El MBE MBE Completed E-Verify Form Attached El El ❑YNoes <br />F] <br />Project Name <br />Project Number <br />Funding Source <br />Comes out of event funds. Not operating funds <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Professional building leaning services at the Leighton (Morris) <br />theater, Palais Royale and Granada Lounge <br />For Change Orders Only <br />Amount of ❑ increase $ <br />E] Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% Work.4 <br />New Amount <br />Total Percent of Chan <br />Time Extension. <br />Copy <br />Original <br />El <br />F] <br />El <br />F1 <br />El <br />n <br />