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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11115 no NO <br />Name Benjamin Dougherty Department Admin & Finance <br />.BPW Date August 28, 2018 Phone Extension 7678 <br />Required Prior to Submittal to Board <br />Legal' Attorney Name Elliot Anderson <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F-1 <br />L-1 <br />Agreement <br />H Contract <br />0 Proposal El Addendum <br />M <br />Professional Services <br />❑ Amendment <br />F-1 Bid Opening <br />El <br />Bid Award <br />El Req. to Advertise F-1 Title Sheet <br />F-1 Quote Opening <br />El <br />Quote Award <br />EJ <br />Chg Order No. <br />F-1 C/O & PCA No. <br />❑ <br />PCA <br />El <br />Ease./Encroach. <br />F] Traffic Control <br />EJ <br />Resolution <br />F] <br />Other: <br />n <br />Claim <br />Company or Vendor Name <br />New Vendor <br />I <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of EJ <br />El <br />Re uired Information <br />Fifth Third Securities, Inc. <br />M Yes El If Yes, Approved by Purchasing <br />4J'sk-, <br />El MiBE Completed E-Verify Form Attached El Yes <br />n WBE [:] No <br />Econ, Dev. Rev. Bonds, Series 2018 (Potawatomi Zoo ProiE <br />453-1104-452.,38-04 <br />NTE $3.37 per thousand of par amount (est. total = $14,575.25) <br />Fixed fee, payable from bond proceeds. <br />Underwriter services for preparation and negotiated sale of tax- <br />exempt, 501(c)(3) qualified bonds in support of zoo capital <br />projects (pursuant to PZS Lease and Management Agreement). <br />For Change Orders Only <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />E] <br />