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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 17, 2018 <br />Name Austin Gammage Department _DCI <br />BPW Date April 24, 2018 Phone Extension 5842 <br />F-, Required Prior to Submittal to Board <br />Legal Z Attorney Name Elliot Anderson <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 F <br />Check the _Appropriate Item Type — Required forAll Submissions <br />F-1 Agreement ❑ Contract El Proposal El Addendum: <br />❑ Professional Services M Resolution <br />F-1 Bid Opening E] Bid Award El, Req. to Advertise El Title Sheet <br />Fj Quote Opening El Quote Award <br />E] Change Order No. F-1 C/O & PCA No. F1 PCA <br />F-1 Ease/Encroach. ❑ Traffic Control <br />F Other: <br />Company or Vendor Name <br />New Vendor <br />MBEMBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />FATW . 11=1 <br />Project Impact <br />Aso 0 -a 9 <br />FAIM 11=0 <br />Project Impact Development Center <br />18JO20 <br />am <br />404-1001-460-39.30 <br />$30,000 <br />Terms of Contract Donation of funds to set up a new office. <br />Purpose/Description To support this non -profit's local business development and community <br />service efforts. <br />F Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of F-1 increase <br />[] Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />N <br />El <br />M <br />F-1 <br />0 <br />0 <br />Dispersal After Approval <br />Austin Gammage <br />Elliot Anderson <br />Love <br />