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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/23/2018 Department Public Works <br />Name Toy Villa i4 Division/Bureau Engineering <br />.._..____... _ _..___ _.. __m............ — - ..—ww_-........- <br />BPW Date 11 /13/2018 Phone Extension 5920 <br />i �� •Ww•� ��,����;�wuHuuuumpuoHiHiHumr�ir�r�w��r������+;� �,¢ra� �,^�swvv^a a.e�aaatrwrerr.. ,rr:��w:..m ����� � ,„,� rw,�;mormwxm�rv�arv�n.�ir�:�,,rv,�p aU,����+�+.;n�uwlluw� � � ;�rrr. <br />-µ- R uired Prior to Submittal to <br />,��..m ,� _._.. <br />.....����. .. Board .� �....... <br />m_... ....._ ...... -ww. <br />Legal El Attorney Name: <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 />Agreement - <br />Amendment <br />ent <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />O' Ease/Encroach. <br />[❑ Other: <br />Company or Vendor Name <br />LJ Contract <br />[� Resolution <br />[� Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo <br />❑ 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 />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: /o <br />Copy <br />Original <br />F1 <br />❑ <br />)r All Submissions <br />Proposal ❑ Addendum <br />E Req. to Advertise ❑ Title Sheet <br />® PCA <br />n <br />Pemberton Davis Electric, LLC, <br />Project Closeout <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination,. Non -Debarment., E-Verifv, Iran, etc. <br />