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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />3/28/18 <br />Michelle Smith <br />Department Util <br />BPW Date 4/10/18 Phone Extension 5994 <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F1 <br />n Agreement <br />F-1 Professional Services <br />R Bid Opening <br />F] Quote Opening <br />El Chg1 Order No. <br />Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />FARTNINVO11111130711107 on <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />R Contract <br />[I Amendment <br />El Bid Award <br />El Quote Award <br />No <br />El Traffic Control <br />El Req. to Advertise <br />F1 Title Sheet <br />KERAMIDA <br />El Yes ❑ if Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached F] Yes <br />WBE 0 No <br />Statistical Analyses of Groundwater Sampling Events <br />Organic Resources Other Contractual <br />641-0631-793-63-3,5 <br />Purpose/Description IDEM required statisticali evaluation for groundwater data from <br />closed biosolids landfill at Organic Resources Fag lit <br />For Change Orders ON <br />Amount of F1 increase $ <br />[:1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % . .... .... ... . ...... ........ . . ..... . ..... <br />New Amount $ <br />Total Percent of Change: °l® <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />❑ Z Brian Harrington - KERAMIDA <br />0 Emily Leyes, — Utility Fiscal Officer <br />El <br />