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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /06/18 <br />.. <br />Name � S.u... E �...�_____w. <br />e Ellen Doudrick <br />Department Public . Works <br />......... ..........__. _ ­ <br />Division/Bureau Engineering <br />BPW Date 11/13/18 Phone Extension 5922 <br />WtlONNVNlrflf4h"T9'W9WW!T"vo 3 cNif vmrmvm rrrawm�va�mmvcawa�4HE4E�3�'&.�A94f�Evfl/A"iW19MIkINmIMMI �W4V�'WYN�/JM�MJatWI{XJd'dMi�C:IA Ra�4�f.99!AR„kFVIA N%/dP.fAYNYMY' urs�w.�srmv ' . per,'/��p���i�iwwww d <br />Rewired Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ Michael Schmidt <br />_ Check the.Anro riate Item Tvngm — Paryid orl for All Submissions <br />Agreement Amendment <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />Contract <br />El Resolution <br />Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo <br />n Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Proposal <br />® Req. to Advertise <br />uired Information <br />❑ PCA <br />Addendum <br />® Title Sheet <br />Small Drainage Improvements to 1) Olivia Circle 2) Creekwood <br />_ r Hawbaker Street <br />Purpose/Description Estates ... ..._ . �... <br />._..... q d Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />,...... ._.... m _._.._ - <br />Reouired For Chae Orders Only <br />$ <br />Amount of - Increase .. ........ .................... �d f <br />Decrease $ <br />m ........_ ... w� �� <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount .. .. <br />.�.. <br />Total Percent o Change: <br />Dt�eral After.�?�°�a�l! <br />Copy Original <br />m� <br />® Kara Boyles <br />® El Sue Ellen Doudrick...�.................................�.�.�.�_�.�_................_. �...�.............................................._�mm.......w �.��.. <br />