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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 28, 2019 <br />Name Becca Plantz� <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date January 8, 2019 Phone Extension 5998 <br />uuur�ziw� myu � m¢ � r��r�oomm�mm �.... uw��!�wwu!wwwwwwwwwwwwwwwwwwuiwrcrcmp�mu�u�;rra:�wn �u�mmomomo <br />._. ...... .................. <br />Prior <br />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 />�__._.. Check the <br />LJ Agreement Amendment <br />El Professional Services <br />Bid Opening <br />❑ Quote Opening <br />F-1 Change Order No. <br />Ease/Encroach. <br />Other: <br />111701riate Item Type — /eq�#d for All Submissions <br />Contract Proposal <br />El Resolution <br />❑ Bid Award ® Req. to Advertise <br />❑ Quote Award <br />n C/O & PCA No. ❑ PCA <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 />Required Information <br />Addendum <br />❑ Title Sheet <br />TBD <br />. �- El Yes MB B [� N�If Yes„ Approved) by Purchasi <br />E <br />N No F1 Yes Name of Comoanv <br />Water Works North PumeincJ Station Well Replacement <br />117-031 R �_..._�. <br />Water Works Engineering_ ...... <br />622.0640.661.31.02 <br />.w��....0.................................................................. ................ <br />TBD <br />Advertise for bidding for the replacement of Well #1 at North <br />Station Well. <br />❑ Required Contractor's Certification Form Attached Non- ....................... <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />_. _....__.. _ _ <br />For CpqgOrders Only <br />EJ Increase $ _.. <br />Amount of � Decrease $ � � �� _�.mm..� <br />0 Board of Paxtc.._ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />Copy <br />Original <br />® <br />❑ <br />Ell <br />0 <br />Becca Plantz <br />Dispersal After <br />