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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Div sion/Bureau En in k <br />Name Toy Villa � .....�. e.... mm...... <br />Date 14 2019 Department Public Ws or <br />g Bring <br />BPW Date 0�..�.....w ,.... ............................_� �.�.�..�.... ................ <br />1 /22/2019 Phone Extension 5920 <br />v r uwwwuwiuiuimwwimuwiuiwuwiuwimuwmmiwmwmwmuuuuuwww�,�„awawrre,��^,r�.,.... oiwm.�ir rwma�m�a�ummu�r�w w�!��wmr�nrtuo�em�urmir�u�ora��nw�o.. �.... <br />�e uired Prior to Submit..��........... <br />._.. w._._......._.._ ._ _.w .... tal to Board <br />_W..w._ ........ .................... _. .. ww� <br />Legal El Attorney Name: <br />Controller El 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 <br />Check the <br />Agreement Amendment <br />[� Professional Services <br />❑� Bid Opening <br />Quote Opening <br />® Change Order No. 3 <br />Ease/Encroach.. <br />Other: <br />Company or Vendor Name <br />►r opriate Item Type — Rec <br />.El .._ Contract <br />Resolution <br />EJ Bid Award <br />El Quote Award <br />El C/O &PCANo. <br />EJ 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 />for All Submissions <br />I Proposal <br />❑ Req. to Advertise <br />Required Information <br />❑ PCA <br />Ziolkowski Construction, Inc. <br />Approval of C.O. #3 <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />