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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4, 2019 <br />Name Kyle Silveus <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date February 12, 2019 Phone Extension 9083 <br />. Re uired PriLtoba <br />SubmittaltoBoarred P'iLe alg ® AttorneyNara 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 ❑ Michael Schmidt <br />Check the A <br />Agreement <br />M Professional Services <br />El Bid Opening <br />Ej Quote Opening <br />El Change Order No. <br />El Ease/Encroach. <br />F 1 Other: <br />)ro nate item <br />T e _ R uired for All Submissions <br />ContractEl Proposal <br />❑ Resolution <br />EJ Bid Award ❑ Req. to Advertise <br />El Quote Award <br />El C/O & PCA No. ❑ PCA <br />P Traffic Control <br />Required 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 />Terms of Contract <br />Purpose/Description <br />Amount of <br />Increase <br />Decrease <br />Addendum <br />❑ Title Sheet <br />United Consulting <br />Yes No If Yes A proved b Purchasing <br />MBE WBE _. . <br />T_7 No <br />CoalYes Name of —Co mra <br />ine Trail Phase I _.._. <br />ENG: 115-063 DES No: 1401810 _ ...... - <br />Riverwest TIF <br />..... <br />�. _ ..M... .... ..... <br />324.1050.460.42 02 <br />_...�_�..­__— <br />Total fee not to exc .... ----- <br />eed. Contract funds are conditional to <br />uqget approyal Redevelopmentb�Commission o _ <br />Sco a includes: Ri ht of Wa Services. <br />..._ <br />Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Previous Amount $ <br />Current Percent of Change: _ <br />New Amount $ - <br />Total Percent of Charw : <br />Copy Original <br />® ❑ Kyle Silveus <br />❑ Chris Dressel <br />El <br />uired For Change Orders Onl <br />------.� <br />Dispersal After Armroval <br />