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Date <br />Name <br />Ham <br />Kyle Silveus <br />BOARD OF PUBLIC WORDS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department <br />Division/Bureau <br />FRIMMIMPAIM <br />Engineering <br />BPW Date 8/28/201,8 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal F] Attorney Name: Clara McDaniels <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 ❑ Michael Schmidt <br />Check the Appropriate Item Tvpe — Required forAll Submissions <br />❑ Agreement <br />F Contract E] Proposal ❑ Addendum <br />F-1 Professional Services <br />F-1 <br />Resolution <br />F Bid Opening <br />El <br />Bid Award Z Req. to Advertise ❑ Title Sheet <br />F-1 Quote Opening <br />F-1 Quote Award <br />E] <br />Change Order No. <br />F-1 C/O & PCA No. F-1 PCA <br />F-1 <br />Ease/Encroach. <br />F-1 Traffic Control: <br />El Other.- <br />Required Information <br />Company or Vendor Name NIA <br />New Vendor 0 Yes El No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor MBE 0 WBE <br />MBEANBE Contractor Requested F-1 No [:] Yes Name of Company <br />Project Name J.C. Lauber Site Improvements <br />Project Number 118-083 B <br />Funding Source RIVER EAST' DEVELOPMENT TIF <br />Account No. 429-11050-460-42.0,3 <br />Amount N/A <br />Terms of Contract Base plus alternates <br />Purpose/Description Parking lot installation, underground stormwater retention, and <br />misc. sidewalk improvements <br />R Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />'Required For Chan e Orders ',Only, <br />Amount of F-1 increase $ <br />El Decrease, $ APPROV11) <br />fteard or 5— <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />1:1 <br />R <br />F-1 <br />F] <br />El <br />1:1 <br />