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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/17/2019 <br />Name _��e Si!veus Department Enaineerin <br />BPW Date 05/14/2019 Phone Extension 9083 <br />flwm <br />. ......... . . . ............ <br />....................... <br />. ......... . . ..i ................ . ...... Required Prior Prior to Submittal to Board <br />mwwwwwww <br />.. . .............. <br />Legal El Attorney Name Clara McDaniels <br />Controller El Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing F-1 Michael Schmidt <br />----------- - — <br />Check the <br />EJ Agreement <br />El Professional Services <br />0 Bid Opening <br />El Quote Opening <br />F1 Change Order No. <br />E] Ease/Encroach. <br />E] Other: <br />)Mrqqu e Item Type - Req� <br />El Contract <br />El Resolution <br />F-1 Bid Award <br />El Quote Award <br />El C/O & PCA No. <br />El Traffic Control <br />Company or Vendor Name TBD <br />for All Submissions <br />Proposal Ad—dendu.-m. <br />Z Req. to Advertise Z Title Sheet <br />ired Information <br />El PCA <br />New Vendor <br />E] Yes n No E] If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />n MBE F-1 WBE <br />MBENVBE Contractor Requested [:] No F-1 Yes Name of Company <br />Project Name <br />Pulaski Park Improvements <br />Project Number <br />118-056 <br />Funding Source <br />TIF on <br />Account No. <br />452-1101-452.31-06 <br />Amount <br />N/A <br />Terms of Contract <br />Base Bid plus Alternates <br />Purpose/Description <br />Pulaski Park Improvements <br />0 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of <br />Required For Chafe Orders 09)y <br />Increase <br />. .................... <br />Decrease IVAL, <br />Previous Amount $ <br />Current Percent of Change: % <br />- - — - - ----- <br />New Amount <br />. . . . . .................... <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />F-1 F-1 <br />F-1 F-1 - ­­­------------------- <br />- - - ­­­­­ - - - - . . ..... . .......... . <br />El El <br />