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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />5/21/19 <br />Department Public Works <br />Name <br />Kyle Silveus <br />.. ....... _... <br />Division/Bureau Engineering <br />— _ <br />BPW Date <br />5/28/19 <br />mm....... m_ <br />Phone Extension 9083 <br />Re uired Prior toIT....._ ._..._ <br />Submittal to Board <br />Legal <br />❑ <br />Attorney Name: Clara McDaniels <br />Controller <br />E] <br />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 />Michael Schmidt <br />_Check the <br />EJ Agreement <br />E] Professional Services <br />❑ Bid Opening <br />Quote Opening <br />F-1 Change Order No. <br />L-] Ease/Encroach. <br />Other: <br />wrrle Item Type — <br />E] Contract <br />Resolution <br />Bid Award <br />Quote Award <br />�] C/O & PCA No. — <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 />Proposal <br />E] Req. to Advertise <br />!red Information <br />TBD on 5/23/19 <br />0 PCA <br />Western Ave. Streetscape - Phase III <br />118-076 _.. <br />324-1050-460-42-03 <br />N/A <br />Addendum <br />❑ Title Sheet <br />Purps of ose/Description se/Descry t on Base ct Lump Sum mm <br />................ <br />p p _ Bid <br />E] Required C.... _..atio Forms . ( <br />ontractor's Certification Forms Attached Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.. µ.� W_ ..........._. <br />.. uwired For Chen e Orders Onl <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount _ �. .�.....�...�� ...,,,., ....... ..... .. _._w .�.��� �� ........� <br />