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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 15, 201� <br />Name Roger Nawra <br />Department <br />Division/Bureau <br />MESM <br />Engineering <br />BPW Date May 22, 2018 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />Legal Attorney Name: Clara McDani6ls <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 0 <br />Check the Appropriate Item Type - Required for All Submissions <br />El Agreement El Contract R Proposal ❑—Addendum <br />F1 Professional Services F-1 Resolution <br />F-1 Bid Opening n Bid Award N Req. to Advertise D'Title Sheet <br />F-1 Quote Opening F] Quote Award <br />n Change Order No. [:1 C/O & PCA No. ❑ PCA <br />El Ease/Encroach. F1 Traffic Control: <br />F-1 Other-, <br />Company or Vendor Name <br />New Vendor <br />MBEA/\1BE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />uired Information <br />n Yes EJ No El If Yes, Approved by <br />Purchasing <br />[:1 MBE F-1 WBE <br />n No El Yes Name of Company <br />Rive,rwalk from Beyer Street to ND Boathouse <br />1 1'7-083A <br />Milo 9 <br />Not to Exceed <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />I Required For Change Orders Only I <br />Amount of H Increase $ <br />F] Decrease $ AP.RO 1D <br />Previous Amount $ Board of Pa tip Works <br />Current Percent of Change: elm <br />New Amount $ <br />Total Percent of Change: % T. <br />i A - <br />Dispersal After Armroval <br />Copy <br />Original <br />❑ <br />F1 <br />El <br />El <br />