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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE, QUEST FORM <br />Date July 24, 2018 Department Engineering <br />Name Toy Villa Division/Bureau DPW <br />BPW Date August 14, 2018 Phone Extension 5920 <br />Controller <br />Purchasing <br />LJ Agreement <br />El Professional Services <br />F-1 Bid Opening <br />F1 Quote Opening <br />F-1 Change Order No., <br />0 Ease/Encroach. <br />F-1 Other: <br />El Attorney Name: <br />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 />1:1 <br />H Contract <br />El Resolution <br />El Bid Award' <br />R Quote Award <br />F-1 C/O & PCA No <br />F-1 Traffic Control: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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 />Amount of F-1 increase <br />0 Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />TX Concrete <br />Proposal <br />F1 Req. to Advertise <br />NEWME, <br />0 E WBE <br />E k . <br />E ki 0■Yes 11.2ittei of Com *,;�tiv <br />2017 Riverside Sidewalk & Driveway <br />118-050 <br />MVH <br />202.0619A31.31.06 <br />$2,224.40 <br />Project Closeout <br />l= 11=40 <br />El Title Sheet <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv, Iran, etc. <br />Total Percent of Change: % <br />Dipersl After Approval...... <br />Copy Original <br />F-1 F-1 <br />1-1 1-1 <br />El El <br />