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130ARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />liz, rf�l i <br />Patrick Sherman <br />Department VP,A <br />BPW Date 04/10/2,018 Phone Extension 5601 <br />. . . . . .......... <br />Requi -1d Prior to Submittal to Board <br />Legal Attorney Name Clara McDaniels <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 <br />H Agreement <br />R Professional Services <br />Ej Bid Opening <br />R Quote Opening <br />R Change Order No. <br />F1 Ease/Encroach. <br />F-1 Other: <br />H Michael Schmidt <br />Contract <br />a, Resolution <br />n Bid Award <br />D Quote Award <br />n C/O & PCA No. <br />F-1 Traffic Control <br />007070M. <br />Req. to Advertise <br />R) <br />PCA <br />Company or Vendor Name TBD <br />New Vendor El Yes El No El If Yes, Approved by Purchasing <br />MBEA(VBE Contractor n MBE n WBE <br />MBEANBE Contractor Requested F] No n Yes Name of Company <br />Project Name VRA-Cemetery Improvements <br />Project Number 1052-2018 <br />El Title Sheet <br />Funding Source Capital <br />Account No. 201-1101-452-36.09 <br />Amount $50,000/yr over 5 years <br />Terms of Contract TBD <br />Purpose/Description Request for Proposal to do repairs, etc. of headstones and other <br />assets within City managed cemeteries. <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non-Debarme,nt, E-Verify, Iran, etc.) <br />Required For Change <br />Amount of F] increase $ <br />El Decrease $ <br />Previous Amount $ A J.TJ_J'0 %IjED <br />Current Percent of Change: %, 40VIIA 01 P(Imic JVCJJ.k8 <br />New Amount <br />Total Percent of Chan <br />Copy <br />Original <br />1:1 <br />Eli <br />F-1 <br />F-1 <br />El <br />F <br />