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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/08/2019 Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />BPW Date 03/26/2019 - ...._.. �....� Phone Extension 5...� <br />_�..����...._._..._ <br />��...... <br />932 <br />�uu mmarm rm�wr rn�ummwuareumw� mmmmmiomin iH imimuuuuuumuuuiuiWMWWE <br />a uired Prior to Submi� ttal to Board <br />LegalAttorney 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 ❑ <br />Check the A <br />m <br />E] Agreement <br />Professional Services <br />Bid Opening <br />❑, Quote Opening <br />Change Order No. 1 <br />Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />rr+ riiap to Item Type. — <br />Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control: <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 />roval of C.O. #1 <br />for All Submissions <br />Q Proposal <br />Req. to Advertise <br />❑ PCA <br />Addendum <br />® Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non- <br />m mmmmm_ m_ __....__ Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />_ .. __ ..- <br />red For �gaC1ig Orders Only--.. <br />Amount of Increase $ 8,780 00 <br />❑ Decrease $ <br />Previous Amount $ 493,000.00 <br />...............__ . _ .. <br />Current Percent of Change: 1.78% <br />_..��...........������...............................................- ......... <br />� <br />New Amount $ 501 ,780.00 <br />Total Percent of Change ......... 1.78% <br />_. _ _.w �ww _._....... .....................� <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />El <br />