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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 2, 2019 Department DCI <br />Name Andrew Netter Division/Bureau Planning <br />BPW Date X 11Z019 Phone Extension 5931 <br />� �mmm�mm�� ., u��uninimunu imuuummm�ymimir��„�xxxr�rra�. -un iar !w!�u�.wwmmimoiwuwmwmro!� erau^n�w w��mvr� .�, a uwrr�eau�uarcsud�n <br />q d Pnor to Submittal to Board ._._ ..I <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 ❑ <br />Check the <br />L Agreement Amendment <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Ell Change Order No. <br />Ease/Encroach. <br />F] Other: <br />Company or Vendor Name <br />r ❑for All Submissions <br />El � Contracm ype—equ�red Proposal <br />❑ Resolution <br />0 Bid Award X Req. to Advertise <br />❑] Quote Award <br />El C/O & PCA No. ❑ PCA <br />0 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 />Required Information <br />Addendum <br />❑ Title Sheet <br />❑ Yes ❑ No�,................................................._»� ❑ If Yes, �..,_........................................�.�.......��.. <br />Approved b <br />Purchasina <br />MBE H WBE <br />No n Yes Name of Com a <br />X 11 15to + tSi Ferrol <br />S "• , <br />LJ Required C6ntractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />....„�_ _ squired For Change Orders Only <br />El <br />Increase $ �-_..t � �•; . ter. � <br />....... <br />Amount of � <br />Decrease ..... <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Chanoe: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />El <br />El <br />Andrew Netter <br />Dispersal After <br />