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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/4/2 0 18 Department Public Works <br />.... . .. .... <br />Name Kyle Silveus Division/Bureau Engineering <br />BPS' Date 9/11/2018 Phone Extension 9083 <br />Reguired Prior to Submittal to Board <br />Legal F-1 Attorney Name: Clara McDaniels <br />Controller ❑ 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 F-1 Michael Schmidt <br />Check the Appr)priate Item Type - Required for All Submissions ❑ <br />F1 Agreement n Contract El Proposal El Addendum <br />El Professional Services n Resolution <br />F-1 Bid Opening ❑I Bid Award ❑ Req. to Advertise Z Title Sheet <br />n Quote Opening F-1 Quote Award <br />F-1 Change Order No. El C/O & PCA No. ❑ PCA <br />El Ease/Encroach. F-I'Traffic Control: <br />F] Other: <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 />ired Information <br />TBD <br />F] Yes [:] No E] If Yes, Approved by Purchasin <br />El MBE [:1 WBE <br />El No 0 Yes Name of Comp <br />any <br />Liberty Tower Exterior Renovations <br />11 8-086A <br />RWDA TI F <br />. . 324-1050-460-42-02 . . ........... <br />TBD <br />Terms of Contract 'TBD <br />Purpose/Descri'ption Base Bid Plus Alternates <br />F-1 Required Contractor's Certification Forms Attached (Non- <br />Coflusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />F_ Required For Change Orders Only <br />Amount of increase $ <br />D Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Chanae: <br />Copy <br />Original <br />F-1 <br />F <br />F-1 <br />F1 <br />El <br />F <br />% j,)oArd ot I rr lror,64 <br />Dispersal After ADr)roval <br />