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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW RE QUESTFORM <br />Name <br />Lauren Trap <br />Department <br />Utilities <br />BPW Date <br />6/26/2018 <br />Phone Extension <br />5852 <br />Legal 0 Attorney Name <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 0 <br />H Agreement <br />Ll Contract H Proposal H Addendum <br />El Professional Services <br />El Resolution <br />F Bid Opening <br />El Bid Award ❑ Req. to Advertise E] Title Sheet <br />M Quote Opening <br />F1 Quote Award <br />F1 Change Order No. <br />F C/O & PCA No. ❑ PCA <br />[:] Ease/Encroach. <br />F1 Traffic Control <br />Z Other: Renewal of <br />EDCOAT,ILLC., Wastewater <br />Discharae Permit <br />Company or Vendor Name <br />New Vendor <br />F1 Yes F: No [:1 If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />F1 MBE F1 VVBE <br />MBE/VVBE Contractor Requested <br />F1 No F1 Yes Name of Company_ <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />❑ Required Contractor's Certification Form Attached (Non- <br />Coflusion, N on-Discri rn i nation, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of increase $ <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />F-1 <br />F-1 <br />Dispersal After Approval <br />