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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Name <br />Kara Boyles/Alicia Czarnecki <br />Department <br />Engineeri <br />_BPW Date <br />08/28/2018 . <br />. ...... — Phone Extension <br />590�3 <br />Required Prior to Submittal to Board <br />Legal Z <br />Attorney Name Clara McDaniels <br />Controller z <br />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 Z <br />Michael Schmidt <br />Check the Appropriate Item Type - Required for All Submissions <br />F-1 Agreement <br />[J Contract n Proposal El Addendum <br />n Professional Services <br />El Resolution <br />F-1 Bid Opening <br />El Bid Award Z Req. to Advertise E] Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />Change Order No. <br />❑ C/O & PGA No. F-1 PCA <br />Ease/Encroach. <br />El Traffic Control <br />F1 Other: — <br />Reauired Information <br />Company or Vendor Name <br />New Vendor <br />F-1 Yes n No El If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />F-1 MBE n WBE <br />MBENVBE Contractor Requested [:] No F-1 Yes Name of Company <br />Project Name <br />Great Lakes Capital Spec Building <br />Project Number <br />118-058 . .... . <br />Funding Source <br />RWDA TIF <br />Account No. <br />324.1050A60A2.04 <br />Amount <br />Terms of Contract <br />Lump sum Ibase bid with alternates <br />Purpose/Description <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of F-1 increase $ <br />E] Decrease $ <br />Previous Amount $e of Iota <br />Current Percent of Change: % <br />New Amount $ ¢a l2 018 <br />Total Percent of Change: % 7:� <br />Dispersal After Approval" <br />Copy Original <br />1-1 F-1 <br />F-1 El <br />El 0 <br />