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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 13, 2018 <br />Name Michael DivjtaDepartment DCI <br />BPW Date September 25, 2018 Phone Extension 5843 <br />Legal Attorney Name Aladean DeRose <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F-1 <br />L] Agreement <br />U' Contract LJ Proposal <br />LJ Addendum <br />E] Professional Services <br />R Amendment <br />F-1 Bid Opening <br />F] Bid Award El Req. to Advertise <br />❑ Title Sheet <br />F-1 Quote Opening <br />El Quote Award <br />❑ Chg Order No. <br />F-1 C/O & PCA No. E] PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control ❑ ResolutionL <br />❑ Other: <br />Claim <br />'Required..Informabori <br />....... . .... <br />Company or Vendor Name <br />New Vendor <br />El Yes n If Yes, Approved by Purchasing <br />F-1 No <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />[:] F] MBE <br />❑Nos <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Adoption of a Fiscal Plan for the Blad Annexation Area <br />For change Orders, Amount of F1 increase $ <br />1:1 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 />1:1 <br />F-1 <br />F-1 <br />n <br />El <br />1:1 <br />