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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 19, 2018 <br />Name . Ro"�..... �...,. .�._..�.................. <br />ger Nawrot <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date November 27, 2018 Phone Extension 5932 <br />�eou�asa�oaru a �iui�oiNv�x� mm.�ammoummimuuuuuuuuuuuuuuum!mr w �n��imb.. ... �.....� ;_J/fi'/d��INN ItlfNi✓'�P. <br />..... Required Prior to Submittal to ...B.oa..rd­..........."I'llv... ..........,, �_._...._W�.... ... <br />... <br />Legal <br />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 <br />Check the <br />H Agreement Amendment <br />® Professional Services <br />:] Bid Opening <br />Quote Opening <br />❑ Change Order No. <br />F] Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />)ro riate Item Type - <br />f 1 Contract <br />LJ Resolution <br />[-1 Bid Award <br />Quote Award <br />C/O & PCA No <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 />Jones Petrie Rafinski <br />�d for All Submissions <br />Proposal — <br />❑ Req. to Advertise <br />❑ PCA <br />oration <br />Addendum <br />❑ Title Sheet <br />J_J Yes No Yes, Approved by <br />Purcha..... n <br />MBE [:1 WBE <br />No D Yes......... Name of Com... ..�— <br />oanv <br />Guardrail Replacement Design <br />�m...._ �—.. <br />118-084 . <br />LRSA — Maior Projects <br />251-0608-431.42-96 <br />$39,515.00 <br />Not to Exceed <br />The design for the replacement of existing guardrail locations <br />and ,new <br />locations <br />throughout the City, <br />......_ <br />LJ ...................................... <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.m�� ............. ...........Re wired For Cha. ...� .---��.. .... »» <br />e........ r Orders OnN! <br />Amount of ❑ Increase $ <br />[� Decrease $ <br />