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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/4/19 <br />Name Jonathan Jones <br />Department Venues Parks & Arts <br />BPW Date 2/12/19 Phone Extension 5812 <br />NNNNNN <br />Reauired Prior to Submittal to Board <br />Legal 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 />N Agreement <br />El Professional Services <br />Ej Bid Opening <br />Quote Opening <br />❑ Chg Order No. <br />Ef' Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />iropriate Item Type — <br />F1 Contract <br />❑ Amendment <br />El Bid Award <br />Quote Award <br />C/O &PCANo. <br />(� Traffic Control <br />Vermont <br />❑ Yes <br />® No <br />[:] MBE <br />WBE <br />'for All Submissions <br />Proposal C] Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />ired Information <br />tems, Inc. <br />PCA <br />Resolution <br />Claim <br />J If Yes, Approved by Purchasing <br />Completed E-Verify Form Attached ❑ Yes <br />❑ No <br />OPeratin <br />........................ ___ _._....._ <br />279-0672-415.36-04 <br />.�..�...�.._ ........ <br />Amount of H Increase $ <br />E] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />