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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/19/18 <br />Name Tara Weigand <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 3127/18 Phone Extension 5998 <br />Reauired Prior to Submittal to Board <br />Legal ❑ Attorney Name: <br />Controller ❑ 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 El <br />LJ Agreement Amendment <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑] Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />Contract <br />Resolution <br />o•• <br />F-1 Bid Award ❑ Req. to Advertise E] Title Sheet <br />0 Quote Award <br />❑ C/O & RCA No. ❑ PCA <br />H Traffic Control-, Residential Handicap Parking <br />New Vendor <br />MBEMBE Contractor <br />MBEIWBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />❑'i Yes ❑ No E] If Yes, Approved by <br />Purchasing <br />❑ MBE U WBE <br />F-1 No F-1 Yes Name of ComDanv <br />Residential Handicap Parking — 912 Leland:, Avenue <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non-Debairment, E-Verify, Iran, etc.) <br />ara <br />Copy Original <br />M ❑ Roger Nawrot, Assistant City Engineer <br />❑ Ed Gileckler, Manager Bureau of Traffic & Lighting <br />SBPD <br />