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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Julv 5, 2018 <br />Name <br />Carl Littrell <br />Department <br />DPW Engi Leering .. <br />B,PW Date ._.-July <br />10, 2018 <br />Phone Extension <br />9149 <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F-1 <br />H Agreement <br />F-1 Professional Services <br />F-1 Bid Opening <br />D Quote Opening <br />F-1 Chg Order No. <br />F-1 Ease./Encroach. <br />Other: Permission to <br />Enter <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 />❑ <br />H Contract <br />0 Amendment <br />El Bid Award <br />F] Quote Award <br />n C/O & PCA No. <br />E] Traffic Control <br />liam <br />15.0170-TTAT4171 ri, <br />F-1 Req. to Advertise [:] Title Sheet <br />[:1 PGA <br />F-1 Resolution <br />F-1 Claim <br />Indiana Michigan Power and Contractors /+-S1)/LtvLcU <br />El Yes Fj If Yes, Approved by Purchasind 8e.LA.5v <br />M No <br />F1 MBE Nis <br />Completed E-Verify Form Attached F-1WBE <br />I&M Transmission Line <br />N/A <br />N/A <br />Gives I&M and its Contractors p ermission to travel through land <br />City owns for retention basin at west end of West Calvert Street. <br />I&M needs to clear trees and brush from adjacent land, but is <br />stvmied by ditches for direct access. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />11 n <br />El El <br />