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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date, <br />September 17, 2018 <br />Department <br />Public Works <br />Name <br />Scott Kreeger--. . . ...... <br />Division/Bureau <br />--Engineering <br />BPW Date <br />September 25, 2018 <br />Phone Extension <br />9�245 <br />Required Prior to Submittal to Board <br />Legal 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 Z Michael Schmidt <br />Check the Appropriate Item Type - Required for All Submissions <br />Agreement Amendment [:] Contract El Proposal El Addendum <br />❑ Professional Services F-1 Resolution <br />Fj Bid Opening F-1 Bid Award Z Req. to Advertise [ATitle Sheet <br />F-1 Quote Opening F-1 Quote Award <br />[:1 Change Order No. El C/O & PCA No. ❑ PCA <br />El Ease/Encroach. ❑ Traffic Control: <br />El Other. <br />- <br />Reauired Information <br />New Vendor <br />MBEANBE Contractor <br />MBE/BE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No,. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />[::] Yes El No F-1 If Yes, Approved by <br />Purchasina <br />MBE Ll WBE <br />No F-1 Yes Name of Co <br />VPA Restroom Remodeling <br />118-043 <br />471-1138-452.42-01 <br />Parks Bond I <br />Request to Advertise on September 28th and October 5th <br />" Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F-1 increase $ <br />F-1 Decrease$ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount $ nNoirks <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />z El Patrick Sherman, Project Manager <br />z ❑ Kara Boyles <br />z F-1 <br />