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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/19/19 <br />.. ... .-11,11, ...... . ... <br />Name Charlotte Brach <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 2/26/19 Phone Extension 9246 <br />....... Required Prior to Submittal to Board . . . . ....... . . ............. .. .. . ......... <br />Legal F-1 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 0 <br />Check the <br />Agreement <br />Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />El Change Order No. <br />7 Ease/Encroach. <br />F] Other: <br />iropriate Item Type — Required for AH Submissions ' Contract El Proposal <br />Resolution <br />0 Bid Award ] Req. to Advertise <br />Z Quote Award <br />n C/O & PCA No. ❑ PCA <br />n Traffic Control: <br />Required Information <br />Addendum <br />D Title Sheet <br />Company or Vendor Name Ritschard Bros., Inc. <br />F-1 Yes 0 No If Yes, Approved by <br />New Vendor Purchasinq <br />--------------- <br />MBE/WBE Contractor MBE WBE <br />MBEIWBE Contractor Requested ❑ No [:]'Yes Name of'Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />nLina -- ite Improvements <br />Unit Cenr <br />117-050 R <br />RWDA TIF <br />324-1050-460-42.01 <br />$69,160 <br />Base Quote <br />Open Market Contract - Util <br />Connections for -Unity Gardens <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />...... . ..... . .... . .. . . ...... . . . .............. . . . ..... <br />.._..._.,,_.Peq4Lired For Char Orders Onl............ <br />Amount of F-1 Increase $ .............. <br />[_1 Decrease$ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />. ............ <br />Total Percent of Change: % <br />Disi)ersal After <br />Copy <br />Original <br />F-1 <br />F] <br />F-1 <br />F-1 <br />