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3-M <br />Kyle Silveus <br />6/26/2018 <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE VIEW REQUEST FORM <br />Department <br />INA4_6401,0400r. <br />Phone Extension <br />Public Works <br />EMMM <br />M., <br />Required Prior to Submittal to Board <br />Legal El Attorney Name: Clara McDaniels <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 Michael Schmidt <br />Check the Appropriate Item Type — Required for All Submissions <br />F-1 Agreement El Contract 0 Proposal El Addendum <br />❑ Professional Services El Resolution <br />❑ Bid Opening El Bid Award Z Req. to Advertise El Title Sheet <br />❑ Quote Opening n Quote Award <br />❑ Change Order No. F-1 c/o & PCA No. ❑ PCA <br />❑ Ease/Encroach. El Traffic Control: <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Required Information <br />N/A <br />Fat Daddy's Building Demolition <br />118-066 <br />River West TIF <br />324-1050-460-39.82 <br />N/A <br />Demolition of the existing Fat Daddy's Building <br />F] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, ]ran, etc.) <br />Amount of increase $❑ ft" of PaWW Works <br />Decrease ----$,- <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />NSDersal After Aooroval <br />Copy <br />Original <br />F <br />F <br />El <br />1:1 <br />El <br />El <br />