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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 19, 2018 <br />Name......Toy <br />...Villa <br />...........�w— ................� <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date November 27, 2018 Phone Extension 5920 <br />�ivum�wiNN rfwmemai�uuuuuuuuuuuuuuuuuuuuuuuumuwimwwuw ,�uu�u�rr�zmw ervx�ne� x��� mo�mm�imm�mmmuuuuuumumwauuuiuiuiuiuiurvrvm��n,� <br />w_ ....... ..... Required Prior to SubmittaltoBoard <br />Legal E Attorney Name: <br />Controller El 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 0 <br />Check the A <br />❑ Agreement....�....www <br />❑ Professional Services <br />[ Bid Opening <br />j Quote Opening <br />[� Change Order No. <br />Ease/Encroach. <br />�I Other: <br />(1A!eJ!eM1YRE <br />T <br />F] Contract <br />F] Resolution <br />[' Bid Award <br />F1 Quote Award <br />® C/O & PCA No <br />❑ Traffic Control: <br />Company or Vendor Name <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 />Required for All Submissions <br />........ ............ <br />Proposal <br />❑ Req. to Advertise <br />4 Final ❑ PCA <br />!red Information <br />C...& E Excavating. „ Inc. <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non Debarment, E-Verify, Iran, etc. <br />euired For Chan�ae Orders Only ..._._.. w <br />Amount of E] Increase $ <br />Decrease $....30.................... <br />............... 982.72 <br />Previous Amount $1 „371,163.72 <br />Current Percent of Change: 2.26% _ ,...................... <br />New Amount $1,340,181.80 <br />Total Percent of Change: <br />Diseersal After <br />Copy <br />Original <br />❑ <br />❑ <br />roval <br />