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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17, 2018 <br />Name ....�B......... ...................... <br />ecca Plantz <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date December 20, 2018 Phone Extension 5998 <br />�„r+ ��wwuw+ nnmar snira ar ar �ury iWN MIMMMEMIMMMEM MEMPmmmm NIE .w <br />.......... .......... <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 ❑ <br />Checkthe <br />E] Agreement Amendment <br />❑ Professional Services <br />Bid Opening <br />Quote Opening <br />® Change Order No. 1 <br />❑ Ease/Encroach. <br />IV Other: <br />)ropriatewwItem Tyke — <br />❑ Contract <br />❑ Resolution <br />Il Bid Award <br />❑ Quote Award <br />El 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 />for All Submissions <br />I Proposal <br />❑ Req. to Advertise <br />Reauired Information <br />❑ PCA <br />Hourly Not to Exceed, Lumr) Sum <br />Addendum <br />❑ Title Sheet <br />i the Olive Well Field. <br />U Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Disoersal After Aooroval <br />Copy <br />Original <br />® <br />❑ Becca Plantz <br />E <br />El <br />