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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />5/24/2018 <br />Adam Parsons <br />Department Central Services <br />❑ Agreement <br />❑ Contract <br />❑ Proposal j_ J Addendum <br />❑ Professional Services <br />❑ Amendment <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />® Quote Award <br />❑ Chg Order No. <br />❑ CIO & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />I-1 <br />Other: <br />❑ Claim <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Office Interiors <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Carpet for Mayor's Office <br />18-06 <br />CO IT: 404-0617-431.36-01 <br />Amount $11,770.00 <br />Terms of Contract <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />® <br />❑ <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Shay Davis <br />Laura O'Sullivan <br />