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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />1 /07/18 <br />Michelle Smith <br />Department Utilities <br />BPW Date 1/22/19 Phone Extension 5994 <br />•—*.- ,m, 50 :......:..............,� .rtaw�:mva�wn., ��r xwuwuww �wrevmv ,. .... mH�r: avam�r� uMiwIMUMirri�. .: . uwm�m uwuwwmMimuu ry�mvq... rr. �,rraamvvu �r <br />Rewu�red Prior to Submittal to Board <br />....... ..�.._... ........... <br />.._........ <br />Legal X Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the...A <br />Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑' Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />F-1 Other: <br />iiropriate Item mType — Required" for All Submissions <br />Contract Proposal <br />Amendment <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Award <br />El C/O & PCA No. ❑ PCA <br />Traffic Control ❑ Resolution <br />Claim <br />Reauired Information <br />............._.... <br />Addendum <br />❑ Title Sheet <br />Companyor Vendor Name <br />USYDepartment of the Geological Survey <br />........wlntterioor/ ed....... <br />New Vendorby <br />Yes, PP___.. .....___ .. <br />Purchasing <br />® No <br />MBE/WBE Contractor <br />❑ MBE Completed E-Verify Form Attached El Yes <br />0WBE ❑ No <br />Project Name <br />Joint Funding Agreement for Water Resource Investigations <br />LL <br />Project Number <br />00GWQ <br />Funding Source <br />Water Works Oetional Fund <br />Account No. <br />620.0640.658.31.35 <br />Amount <br />$3000 <br />Terms of Contract <br />Purpose/Description <br />Annual a reement for water level measurement and analysis <br />For Change Orders Only ITITm w w <br />Amount of El increase $ <br />El Decrease $ <br />Previous Amount ,...,_.... ._._. <br />w � �..........................................� _. �.......�.�.............................w_w ��......................................m.._ .��.._��.....�...��. <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: �% <br />g <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />® Paul Buszka <br />® <br />Roxanne Lawson <br />on <br />® <br />❑ Michelle Smith <br />