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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />08/08/2019 <br />Patrick Sherman <br />Department VPA: F&G <br />BPW Date 08/13/2019 Phone Extension 5601 <br />wrvmriwmiHUHuummmmuuuuuuuuumuummummmuuuuHUHUHmHuuuuuHUHuuuuuHUHUHUHuuuuuuuuuwuwuwimiuiuiuiuiuiuiuiwwuwiuiwuwuwuwiwwuiw� .. �nmr�awioioiaw�wr s.. ,� W �rerzmmmmwmm�mrmr�a... <br />Required 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 />❑ Quote Opening <br />Change Order No. _ <br />El Ease/Encroach. <br />Other: Disnosal <br />Company or Vendor Name <br />pro_p�Pwltem T _ e _ Reg, <br />Contract <br />Resolution <br />El Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />El Traffic Control <br />for All Submissions <br />Proposal <br />El Req. to Advertise <br />uired Information <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor E] Yes E] 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 Disposal of obsolete property <br />_.....�................................................................................... <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description R Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Chahq Ord ers Ot!! <br />El Increase $ <br />Amount of ..... m_ ...... . ,,�.. <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change, - <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />El E] <br />