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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 />2 a a IMA M 11 0M <br />Engineering <br />BPW Date 3/27/18 Phone Extension 5998 <br />Legal F-1 Attorney Name: <br />Controller El 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 />H Agreement Amendment <br />EJ Professional Services <br />El Bid Opening <br />F-1 Quote Opening <br />F-1 Change Order No. <br />F1 Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />Contract <br />Resolution <br />9= <br />Uri 114 154 IM <br />n Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />EJ Quote Award <br />F] C/O & PCA No. F] PCA <br />M Traffic Control: Residential Handicap Parking <br />MBE/WBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />El Yes El No ❑ If Yes, Approved by <br />Purchasing <br />El MBE El WBE <br />F] No 0 Yes Name of Company <br />Residential Handicap Parking — 1814 S Taylor Street <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % ----------- <br />Copy Original <br />F-1 Roger Nawrot, Assistant City Engineer <br />Ed Gleckler, Manager Bureau of Traffic & Lighting <br />❑ SBPD <br />