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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />04/04/2019 <br />Patrick Sherman <br />Department VPA: F&G <br />BPW Date 04/09/2018 Phone Extension 5601 <br />.......... <br />Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels w <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 <br />" Agreement <br />Professional Services <br />E] Bid Opening <br />F-1 Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />11 Other: <br />Michael Schmidt <br />)riate Item Type —Required for All Submissions <br />........ <br />Contract ❑ Proposal <br />I I Resolution <br />Bid Award ❑ Req. to Advertise <br />Z Quote Award <br />IE] C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />Required Information <br />Company or Vendor Name Riedell Skate_ Com an <br />New Vendor ® Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Howard Park Ice Skates & Sharpener <br />Addendum <br />❑ Title Sheet <br />Project Number 1082-2019 _.. _.................... <br />Funding Source Insurance Fund, Cum Cap _ <br />Account No. 226-0419-672.22-23, uand 407-1101-452.42-01 <br />Amount $ 40,950.00 <br />....w_ww ........ ... _............. _...._... <br />Terms of Contract Lump Sum, 10 day lead time <br />Purpose/Description Purchasin rental skates for new Howard Par <br />k Rink <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of Increase _ $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />