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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 1, 2018 <br />Name Tara Weigand <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date June 12, 2018, Phone Extension 5998 <br />Required Prior to Submittal to Board! <br />Legal F-1 Attorney Name: <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 El <br />H Agreement Amendment <br />H Contract <br />LJ Proposal 0 Addendum <br />F-1 Professional Services <br />F-1 Resolution <br />F-1 Bid Opening <br />El Bid Award <br />F-1 Req. to Advertise El Title Sheet <br />El <br />Quote Opening <br />El Quote Award <br />❑ <br />Change Order No. <br />C/O & PCA No. <br />❑ PCA <br />F Ease/Encroach. <br />Traffic Control: <br />Residential Handicap Parking <br />F <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />El Yes Ej No El If Yes, Approved by <br />Purchasing <br />[J MBE E] WBE <br />El No El Yes Name of Company <br />1128 Bissell Street Residential Handicap Parking <br />Recommend Approval <br />[J Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non-Disc0mination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />M F-1 Roger Nawrot, Assistant City Engineer <br />M ❑ Ed Gleckler, Manager Bureau of Traffic & Lighting <br />H F-1 SBPD <br />