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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW RE, QUEST FORM <br />Date 10/15/2018' <br />Name Lauren Trapp Department Utilities <br />BP' Date 10123/2018 Phone Extension 5852 <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller F-1 and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F] <br />,uneCKine P <br />Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />Quote Opening <br />❑ Chg Order No. <br />F-1 Ease ./Encroach. <br />M Other, Industrial <br />Discharge Permit <br />Revision for 18 <br />industries( Please see <br />following page fornames <br />of the Industries) <br />Contract <br />Amendment <br />El Bid Award <br />■Quote Award <br />■C/O & PCA No. <br />El Traffic Control <br />MAN 5 ra T11 <br />R Req. to Advertise [:] Title Sheet <br />Company or Vendor Name <br />New Vendor El Yes ❑ If Yes, Approved by Purchasing <br />F-1 No <br />MBEANBE Contractor F] MBE WBE a <br />Completed E-Verify Form Attached Yes <br />No <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />For Change Orders Only <br />El increase $ <br />Amount of [:1 Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />F-1 El <br />