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BOA1),D OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11MI&M-91M <br />KAe Silveus <br />Department Engineering <br />BPW Date 05/22/2018 Phone Extension 5601 <br />Required Prior to Submittal to Board 7� <br />Legal F-1 Attorney Name Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El Michael Schmidt <br />Check the Appropriate Item Type - Required for All Submissions <br />F1 Agreement F-1 Contract El Proposal El Addendum <br />F-1 Professional Services F-1 Resolution <br />Bid Opening El Bid Award Z Req. to Advertise El Title Sheet <br />Quote Opening El Quote Award <br />El Change Order No. ❑ C/O & PCA No. ❑ PCA <br />R Ease/Encroach. ❑ Traffic Control <br />El Other: <br />Required Information <br />Company or Vendor Name TBD <br />New Vendor El YesEl No F-1 If Yes, Approved by Purchasing <br />MBENVBE Contractor F-1 MBE F-1 WBE <br />MBEANBE Contractor Requested F-1 No F] Yes Name of Company <br />Berlin Place - Site Concrete, Landscape Plantings, and Roof <br />Project Name Pavers <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />11 <br />118-057 <br />RW TI F Bond <br />17JO07 <br />$ TBD <br />Base bid with alternates <br />Site concrete Ilandscape plantings, and Bldg. 4 rooftop pavers for <br />the new Berlin Place development. <br />F-1 Required Contractor's Certification Form, Attached (Non <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, <br />Required For Chanqe Orders Only <br />Increase $ <br />Decrease $ APPROVED <br />[Dr,=%An"o Amount t uskru of V 11c Works <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />1:1 <br />❑ <br />F-1 <br />El <br />El <br />