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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /4/2018 <br />Name Suzanna FrItzberq, Department Mayor's Office <br />BPW Date Phone Extension <br />Legal Attorney Name Clara <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />VJ Agreement <br />❑ Professional Services <br />Bid Opening <br />El Quote Opening <br />Chg Order No. <br />El Ease./Encroach. <br />n 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 />Contract <br />Amendment <br />El Bid Award <br />Quote Award <br />❑ C/O & PCA No, <br />0 Traffic Control <br />St. Jose <br />[ Yes <br />❑ No <br />❑ MBE <br />WBE <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />El Resolution <br />Claim <br />h County Health Department <br />If Yes, Approved by Purchasing <br />Addendum <br />❑ Title Sheet <br />Completed E-Verify Form Attached [I Yes <br />No <br />Lead Paint Analyzer Donation <br />18JO14 <br />EDIT <br />408-1001-460-39.30 <br />$26,516 <br />wwwwW <br />City to donate $26,516 for purchase of XRF lead paint analyzer <br />and associated maintenance, as well as compilation of lead <br />safet kits for ublic distribution <br />�' Increase $ <br />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 />❑ <br />❑ <br />0 <br />El <br />El <br />❑ <br />