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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />3-4-2019 <br />Kim Thompson <br />Department Utilities <br />BPW Date 3-12-19 Phone Extension 5969 <br />Id1�N'�nM010WWWOW�WIMIIIWIAmeHhM;tiHHIY�VNIIWII�'1WI� kk„MIIMPoI�VWImvnrswrx",atl'VNOI�,i iBO'W;NpNi'!//(3/ x IIINIV� WYA�PoYfii �m�iWf�pm i�l�+e�+re'%rylll�l��°b"dW�M'N'W'�/,;P��'J,WWv`3�Li Fff <br />� b <br />Legal Prior to Su .. �. .�. � .�.. .....�� <br />mittal to Board <br />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 />hec k the <br />Agreement <br />® Professional Services <br />Bid Opening <br />El Quote Opening <br />Chg Order No. <br />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 />(� Contract..e <br />)ro ria a Item <br />j Amendment <br />El Bid Award <br />El Quote Award <br />El C/O & PCA No. <br />❑ Traffic Control <br />Superion <br />'for All Submissions <br />I <br />❑ Req. to Advertise <br />uired Information <br />El PCA <br />E Resolution <br />Claim <br />LJ Yes H If Yes, Approved by Purchasing <br />No <br />[� MBE Completed E-Verify Form Attached <br />❑ WBE <br />Stormwater Fee setup <br />Water O&M <br />620-0640-657.31-35 <br />$5120.00 <br />k stormwater fee to all existin accounts <br />Addendum <br />❑ Title Sheet <br />El Yes <br />No <br />For ChanOrders Ong .....w...m. <br />Amount of Increase <br />Decrease$........��_�.�..............��—,�.���.�.�.��_� <br />Previous Amount <br />Current Percent of Change: <br />�.........._ off._ ......��.. ...._���....�.._� ... .��.� ....� _�...._��.. ... <br />9 0 <br />New Amount <br />Total Percent of Change: ......._ %......._........� � .......�_.....-_-__...�... <br />Time Extension: <br />Copy Original Dispersal After Approval �.�....................� �.�..��....�.� ...... <br />❑ Kim Thompson <br />EJ 0 Roxanne Lawson.. -......""...—." ...................... <br />