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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 18, 2018 <br />Name Charlotte Brach <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 20, 2018 Phone Extension 9246 <br />mFIVIMMn».wamm000mmm mmioommmowrmi000mum <br />_Required 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 R <br />Check the, <br />H Agreement Amendment <br />El Professional Services <br />E] Bid Opening <br />]� Quote Opening <br />Change Order No. <br />❑ Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />Michael Schmidt <br />�ropriate Item Type 1p uired for All Submissions <br />Fj Contract E Proposal <br />Resolution <br />0 Bid Award E] Req. to Advertise <br />® Quote Award <br />❑ C/O & PCA No. PCA <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 />ReQuuired Information <br />Walsh .....&..... Kelly, .....Inc. .............� <br />❑ Yes ❑No <br />Purchasing mm mm <br />MBE WBE _ <br />F1 No Yes Name of Comb <br />Civic Byway Repaving <br />118-110 <br />Complete Streets Transportation <br />4-1001-4 2.30 <br />$50,692.51 <br />Base Quote..........................w..... <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by <br />Repaving alleyway adjacent to the Civic Theater <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />._ Required For C w <br />a! g mOrdersuu r Iy _ <br />Amount of Increase $ .... _. ..... . ,_..�. <br />El Decrease $ <br />