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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />9-01� <br />Tara Weigand <br />Department <br />Division/Bureau <br />N"Myfoll <br />Engineering <br />BPW Date 8/28/18 Phone Extension 5998 <br />Legal ❑ Attorney Name: <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />L_j <br />Agreement Amendment <br />H Contract LJ Proposal H'Addendurn <br />F-1 <br />Professional Services <br />n <br />Resolution <br />n Bid Opening <br />El <br />Bid Award El Req. to Advertise nj Title Sheet <br />F-1 Quote Opening <br />❑ <br />Quote Award <br />[:] <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />F-1 <br />Ease/Encroach. <br />Traffic Control:_R,esi'dential Handicap Parking <br />F-1 Other: <br />Company or Vendor Name <br />El Yes E] No ❑ If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBEANBE Contractor <br />[J MBE [:] WBE <br />MBEANBE Contractor Requested <br />n No El Yes Name of Company <br />Project Name <br />1942 E Fox Street Residential Handicap Parking <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Recommend Approval <br />F1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.} <br />Required For Change Orders Only <br />Amount of El Increase <br />EJ Decrease <br />$ <br />$ <br />Previous Amount $ <br />Current Percent of Change: <br />% <br />New Amount $ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />copy Original <br />Roger Nawrot, <br />Assistant City Engineer <br />❑ F-1 Ed Gleckler, Manager Bureau of Traffic& Lighting <br />z F-1 SBPD <br />