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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 0�6/1!8/2018 <br />Name Toy Villa -,a Department Engineering <br />BPW Date 06/26/2018 Phone Extension 5920 <br />Legal ❑ 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 1:1 <br />HI Agreement <br />F1 Professional Services <br />[:1 Bid Opening <br />E] Quote Opening <br />F] Change Order No. <br />❑ Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBENVBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />LJ Contract LJ Proposal Ll Addendum <br />F-1 Resolution <br />F] Bid Award El Req. to Advertise Title Sheet <br />❑ Quote Award <br />C/O & PCA No. PCA <br />El Traffic Control <br />-Gibson-Lewis, LLC <br />El Yes M No E] If Yes, Approved by Purchasing <br />F] MBE F-1 VVBE <br />F] No F-1 Yes Name of Compan <br />2017 Central Services Remodel <br />117-118 <br />Capital Budget <br />224.0605.419A310 <br />Project Closeout <br />El Required Contractor's Certification Form Attached (Non <br />Collusion, Nan -Discrimination. Non -Debarment. E-Verifv. 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 />Copy Original <br />0 F1 Mary Wisnewski <br />El F1 <br />El 1:1 <br />