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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 6, 2018 Department Public Works <br />Name Alicia Czarnecki/Patrick Sherman Division/Bureau Engineering <br />BPW Date November 13, 2018 Phone Extension 5903 <br />4i lu fii 2�'H 'N� ^ mmlw�lw�lw�u�u�w�lw�u6'iullydm: ... g�/d�ltA/!➢RIkYkArW➢�", lii v A.... W„M :f �.... ffMX'�4 !YAtlwDfrY^,�+wv w ,NwWYRml <br />�.mm mm_. ITITITIT m ITIT _._. Required Prior to Submittal toBoard�� ITITITITITITm �mm� <br />Legal Attorney Name: Clara McDaniels <br />Controller ❑ 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 El <br />Check the <br />greement Amendment <br />Professional Services <br />❑ Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />iropriate Item Type — <br />Contract <br />0 Resolution <br />❑ Bid Award <br />El Quote Award <br />C/O & PCA No. <br />J Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />R <br />for All Submissions <br />Proposal — <br />❑ Req. to Advertise <br />uired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />[J Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount$ <br />Total Percent of Chancre; <br />Copy <br />Original <br />E <br />El <br />® <br />❑ <br />® <br />❑ <br />Dispersal ..........�......... <br />After <br />Scott Kreeger, Project Engineer <br />Kara Boyles, City Engineer, PE. <br />m.Patrick Sherman, VPA Project Manager <br />........... ............. <br />