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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />June 18. 2018 <br />F05111111101 <br />Department UtilitiesMater <br />BPW Date June 26, 2018 Phone Extension 6108 <br />Required Prior to Submittal to Board <br />Legal x Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing x <br />H Agreement <br />0 Professional Services <br />Bid Opening <br />❑ Quote Opening <br />F-1 Chg Order No. <br />F-1 Ease./Encroach. <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />LJ Contract , <br />n Amendment <br />F] Bid Award <br />F] Quote Award <br />El C/O & PCA No <br />El Traffic Control <br />x Proposal <br />x Req. to Advertise <br />PCA <br />❑ Resolution <br />Claim <br />Yes LJ If Yes, Approved by Purchasing <br />No <br />ll�w - I �4111 <br />El Title Sheet <br />El No n MBE E Completed E-Verify Form Attached F1 Yes <br />[:] <br />Water Service Line Repair Program Re uest for Applicants <br />Water Works Operating Fund <br />620-0630-711.61-02 <br />Per Program Rate Schedule <br />Advertising to accept plumbing vendors for water service line <br />repair as administered by Water Distribution APP111111M, <br />70 <br />---- ------------ - . ..... . Dispersal After Approval . .................. X ............ <br />Copy <br />Original <br />11 <br />E] Kim Thompson <br />F-1 <br />El Mark Horvath <br />R <br />El <br />