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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4, 2019 <br />Name Roger Nawr of <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date February 12, 2019 Phone Extension 5932 <br />..SIT....... _.,�.�..I�e uired Prior to Submittal to Board <br />Legal � Attorney Name: <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 <br />Agreement <br />Professional Services <br />Bid Opening <br />F] Quote Opening <br />E] Change Order No. <br />Ease/Encroach. <br />D Other: <br />)ropriate Item Torte — <br />Contract <br />Resolution <br />El Bid Award <br />El Quote Award <br />❑ C/O & PCA No. <br />® Traffic Control: <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 />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />ired Information <br />❑ PCA <br />o Parkin Tow Awav Zone <br />Addendum <br />❑ Title Sheet <br />East side of Eddy Street (State Road 23) from E. South _.e._.....w Street to <br />the North 900 feet <br />Reuired .. _W.....�.�........� ,....... _..._�_.....��.�.... <br />q Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.,.. � .,__._.... s <br />euired For �ar�ge Order On <br />Amount of ❑ Increase <br />EJ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />—�----- <br />_ _ . �. �..- .�.......m� .�...w_ m <br />Total Percent of Cha! e:. w ....... /0 ...... <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ Kara Boyles <br />El� Ro er Nawrot <br />