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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/23/2018 Department —Fire <br />BPW Date 5/8/2018 Phone 9255 <br />Name Stephen Cox, Fire Chief <br />. . . . ...... . . ........... . . <br />..... ... . .. . . ..... <br />0 Legal ❑ Attorney Name <br />4- <br />(D 0 — Controller review is required for all Contracts $5,000.00 or more <br />Controller F❑ and greater than one year in length per the City Purchasing <br />0 <br />cr <br />W n Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />_E1 <br />Agreement <br />Claim <br />El Contract I Ll Proposal El Addendum <br />_E1 <br />* <br />* <br />Bid Opening <br />Quote Opening <br />El <br />El <br />Bid Award E] Req. to Advertise ❑ Title Sheet <br />Quote Award <br />El <br />Chg Order No, <br />El <br />C/O & PCA No. <br />El PCA <br />❑ <br />Ease./Encroach. <br />Traffic Control <br />Resolution <br />El <br />Other: <br />,Required Information <br />Company or Vendor Name <br />New Vendor <br />F-1 <br />Yes, 0 <br />No El If Yes, Approved by Purchasing <br />MBE/VVBE Contractor <br />❑_MBE <br />E] <br />WBE <br />Project Name <br />Project (Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Disposal of Unfit/Obsolete property; retirees J. Luccki, D. <br />Maenholut, K. Noell <br />Amount of El increase <br />El [Decrease <br />or Change Orders Only <br />I $ <br />1 $ <br />Previous Amount <br />Current Percent of Change: <br />$ <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />F-1 F-1 <br />El El <br />