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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/17/18 <br />Name Suzanna Fritzbergi <br />.................._� Department Mayor's Office <br />BPW Date 11/13/18 Phone Extension 5818 <br />rc,..�r,�a �tanwra *rnxrm�,xss�mwv... .. is�ns��uuimuimiwwwwnwllwwu�rirw�iri�rer�rr+aiu�u�� ���e,�vs.�s�umrvr�uawuwu�uwr�m�vnvem�wm�+r=: , �rtcnr�w��e��w� ��w;e,�ui »mnn —u v�:�a�¢ <br />...._ ... .__.. o B Re wired Prior to Submittal toard .... <br />Legal Attorney Name Clara <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 n <br />Check wthe <br />[] Agreement <br />El Professional Services <br />E] Bid Opening <br />n Quote Opening <br />Chg Order No. <br />El Ease./Encroach. <br />❑1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />�o ,ate item wwwT�e- <br />Contract <br />❑ Amendment <br />E] Bid Award <br />❑ Quote Award <br />❑C/O &PCANo. <br />E] Traffic Control <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />[� Resolution <br />Claim <br />Addendum <br />❑ Title Sheet <br />For Chan �IT m. F e Orders Oi <br />.,,,....��m ..... ........� � .. Increase ... <br />Amount of $ � '� ��...��..... �. <br />���A. ....... _. .. _..�.. <br />Decrease $ <br />PreviousAmount....m�.......�.�..���.._.�����...�...............�.............................................�.�..�._.�,,,,,..............................�.�....�.�.�.�_.....�. __�............... <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 />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />