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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/18/18 Department Public Works <br />Name Zach HurstDivision/Bureau_....Engineeri.n.g..... .................w_______ . <br />BPW Date 12/20/18 Phone Extension 235-5888 x3057 <br />M �691' WII�I I �IMIGIIW1,lYlgMWAIN/& NNMNIW dIHM�MVNMVWN'MVl�lfm'MONMO@ItiNfPo�IW'J' 1 @RI MWI.MNWMIIWIIIIIIIIIIIIWWIIMMWWWIkI� f(tt!' llf�ibll%IWI <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 El Michael Schmidt <br />Check the <br />H Agreement <br />® Professional Services <br />Bid Opening <br />Quote Opening <br />F1 Change Order No. <br />F-1 Ease/Encroach. <br />Other: <br />T priate Item Type <br />❑ Contract <br />❑ Resolution <br />❑ Bid Award <br />El Quote Award <br />❑ C/O & PCA No. _ <br />❑ Traffic Control: <br />uired Information <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 />for All Submissions <br />6 Proposal <br />Req. to Advertise <br />PCA <br />Addendum <br />❑ Title Sheet <br />Terms of Contract <br />Purpose/Description Architecture and engineering services for the fit -out of 12,382 sft. <br />Inside the western portion of the `Catalyst Two' building in <br />nation Parkor use its IT Innovation de <br />partment. <br />epartment. <br />❑ s Required Contractor's Certification Form .. <br />Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Re uiredmmmFor Change Orders Only <br />Amount of Increase <br />Decrease $ <br />.......,,,_..................,....................... <br />...............................-...............______ ��..m..m..........................�.....�����...��m. <br />Previous Amount $ <br />