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BOARI) OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 29, 2018 <br />Name Tara Weigand <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date July 10, 2018 Phone Extension 5998 <br />. . .......... . . . ...... <br />Required Prior to Submittal to Board, <br />Legal El 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 />L] Agreement Amendment <br />Ll Contract <br />Ll Proposal L1 Addendum <br />R Professional Services <br />El <br />Resolution <br />0Bid Opening <br />El <br />Bid Award <br />El Req. to Advertise Title Sheet <br />F-1 Quote Opening <br />F-1 Quote Award <br />0 <br />Change Order No. <br />F] c/o & RCA No. <br />PCA <br />El <br />Ease/Encroach, <br />Traffic Control: <br />Residential Handicap., Parking <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBEIWBE Contractor Requested <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 />El Yes [:] No ❑ If Yes, Approved by <br />Piurchasina <br />LJ MBE U WBE <br />El No El Yes Name of Company <br />1159 Indiana Avenue Residential Handicap Parking <br />Recommend Denial <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required, F <br />Increase $ <br />Decrease $ <br />$ . ..... <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />F] Roger Nawrot, Assistant City Engineer <br />Ed Gleckler, Manager Bureau of Traffic & Lighting <br />SBPD <br />