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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5 July 2018 Department Public Works <br />Name Amy Kryston Division/Bureau Engineering <br />BPVVDate July 2018 Phone Extension 9246 <br />Legal Attorney Name: <br />Controller |l ContmUorreview �required for aUCon�ado$5.DUU.OUornnoreand <br />�~ greater than one year inlength per the City Purchasing Policy <br />Purchasing R <br />Agreement Amendment <br />L Contract UPmposa| F-1Addendum <br />Professional Services <br />7 Resolution <br />Bid Opening <br />El Bid Award Req. to Advertise FlTitle Sheet <br />Quote Opening <br />Quote Award <br />Change Order No. <br />D C/O &PCANo. PCA <br />ZEaee/Encrnenh <br />[] Traffic Control: <br />F-1Dther <br />Company or Vendor Name <br />New Vendor <br />MBE8NBEContrndor <br />MBE0VBEContractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms ufContract <br />Purpose/Description <br />Indiana_ <br />El Yes EJ No F-1 If Yes, Approved by <br />Purchasing <br />- D No El Yes Name of Company <br />118-042 <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, N on-8iscrimi nation, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of F-1 increase $ <br />1-1 Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />D§persal After Approval <br />Copy Original <br />F Amy Kryston <br />Fl Kara Boyles <br />F-1 11 � <br />