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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February,18 2019 <br />.......... <br />Name Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date February 26, 2019 Phone Extension 5932 <br />�zWw mwwi iuruimmmmmimimmmmioMPW,mmmmmmnmummuumumwmmmnmmmimioummmmuuuuuuuum umumwrr�ama�r znnmrvwm�mmm,�mw nr rrre a�; <br />Required Prior to SubmittaltoBoard <br />Legal ❑ Attorney Name: Clara 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 El Michael Schmidt <br />Check the <br />LJ Agreement <br />❑ Professional Services <br />Bid Opening <br />El Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />�ropriate Item T r _ . <br />[� Contract <br />Resolution <br />® Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />_ <br />E] 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 />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />R <br />E <br />Ll <br />❑ <br />fired for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />uired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by Purchasin <br />)an _ <br />nals at Fire Station No. 9 <br />Division A-LRSA Trafficmmmmmignammmmm aint. Division -EMS Capital Fund. <br />251.0608.431.36.67 287.0902.422.02 <br />$130,027.87.....$41,22.5m..�5.w_.........................._�_ <br />.......................................................................................................................................................................w�w�......— <br />Not to Exceed <br />Dispersal After A <br />