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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />5/31/2018 <br />Adam Parsons <br />Department Central Services <br />BPW Date June 12, 2018 Phone Extension 9302 <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000,00 or more <br />Controller ® and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />❑ Agreement <br />® Contract <br />❑ Proposal ❑ 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 />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />(-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 />Interstate Gas Supply (IGS) <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ WBE BE Completed E-Verify Form Attached ❑ Nos <br />Natural Gas Supply <br />17-019 <br />222-06-17-419.35-02, Natural Gas <br />Previous Amount <br />Current Percent of Change: _ <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Therese Dorau, Office of Sustainabili <br />