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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/17/19 Department Public Works <br />Name Kyle Silveus �_..._ Division/Bureau Engineering <br />______.........................._W.............._._._..._. <br />BPW Date 4/23/19_ �_._...._._....._. <br />Phone Extension 9083 <br />m99 mmmmmmmmmuuuuuuuuuuuuuuumuwuuuuuuuuuuuuuuuuuum winmw�.uawwnm <br />Reauired Prior to Submittal to Board <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 ❑ Michael Schmidt <br />Check the <br />LJ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />F� Change Order No. _ <br />E Ease/Encroach. <br />I Other: <br />rro� Item Type - <br />Contract <br />Resolution <br />Bid Award <br />Quote Award <br />C/O &PCANo. <br />❑ Traffic Control: <br />Company or Vendor Name <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 />for All Submissions <br />I Proposal <br />® Req. to Advertise <br />aired Information <br />❑ PCA <br />Addendum <br />Title Sheet <br />Terms of Contract Lump Sum v.. _m <br />Purpose/Description Base Bid <br />Required Contractors Certification s Attached <br />' Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of El Increase $ <br />El Decrease $ <br />Previous Amount $u <br />............. <br />Current Percent of Change: ,% <br />New Amount $ <br />Total Percent of Change: % �.,.,. <br />�.................�w_ Dispersal After Approvals A ..... .......I <br />Copy <br />Original <br />