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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/02/2019 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 01/22/2019 Phone Extension 5920 <br />Required Prior to Submittal to� ....M <br />� .............. Board <br />Legal F-j Attorney Name: <br />Controller El Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing 1:1 <br />Check the <br />Agreement Amendment <br />EI Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />D Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />rtoprit Item Tyke <br />El Contract <br />Resolution <br />Bid Award <br />El Quote Award <br />[] C/O & PCA No. <br />El Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of Increase <br />Decrease <br />Previous Amount$ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />for All Submissions <br />➢ Proposal <br />❑ Req. to Advertise <br />Required Information <br />Douglas Landscape, mmInc, <br />Proiect Closeout <br />►/ ' <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E Verify„ Iran, etc. <br />squired For Chancre Orders Only <br />Dispersal After Aooroval <br />