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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/11 /2018 <br />Ken Glowacki <br />Department VPA <br />BPW Date Phone Extension <br />mUMMUMIMMmm mmmm� m m m m aim wa�mmwww�u� <br />...w.WW _ <br />............_....�. ..W. ._....... <br />... _..�.�.� ....�.�.. <br />Prior to Submittal Board <br />_...... . Required P_ ttal tooa <br />� ......._.. _ ....._. _..._.._.._._.....�. <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check W ck the p <br />Agreement <br />Professional Services <br />[J Bid Opening <br />El Quote Opening <br />E] Chg Order No. <br />[� Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />)ro r�iate Item Type — <br />El Contract <br />El Amendment <br />Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. — <br />Traffic Control <br />'for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />red Information <br />PCA <br />Resolution <br />Claim <br />Addendum <br />❑ Title Sheet <br />Larson Danielson construction Co., Inc. <br />❑ Yes If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Howard Park Reconstruction <br />1 st Source Bank Escrow Agreement for HP Reconstruction <br />pro lect <br />For Change Orders O <br />Amount of Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />0 <br />El <br />