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BOARD OF PUBLIC WOR1,,S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/2018 <br />Department Public Works <br />Name Hana Parkhill <br />Division/Bureau Engineering <br />BPW Date 10/23/2018 <br />Phone Extension 5961 <br />Required Prior to Submittal to Board <br />Legal r_1 <br />Attorney Name: Clara McDaniels <br />Controller El <br />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 1:1 <br />Check the Appropriate <br />Item Type - Required forAH Submissions <br />❑ Agreement Amendment <br />n Contract El Proposal El Addendum <br />❑ Professional Services <br />n Resolution <br />n Bid Opening <br />E:1 Bid Award Req. to Advertise F-1 Title Sheet <br />❑ Quote Opening <br />F-1 Quote Award <br />❑ Change Order No. <br />El C/O & PCA No. El PCA <br />F-1 Ease/Encroach. <br />El Traffic Control: <br />R Other: General Release <br />Company or Vendor Name <br />TBD <br />F1 Yes R No F1 If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />F1 MBE El WBE <br />MBE/WBE Contractor Requested <br />F-1 No 0 Yes Name of Comparly <br />Project Name <br />2018 Demolitions <br />Project Number <br />118-307 <br />Funding Source <br />C.01T <br />Account No. <br />404-1201-415-39-87 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Work includes the demolition of Vacant and Abandoned Homes. <br />0 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc,) <br />Amount of [:] increase $ <br />F-1 Decrease $ AVVr191vv4!* <br />. I - � V <br />Previous Amount 13,aurd I)f <br />Current Percent of Change: % <br />New Amount �Olel 4 <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />M n Kara Boyles, City Engineer <br />H Fj Tracy Skibins <br />F-1 Toy Villa <br />