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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date_.,8/2/19.....................�................._..�.�.... <br />Name Central Services <br />Department Central Services <br />BPW Date 8/13/18 Phone Extension 9316 <br />Wk'dWWdBffMOWWfffi MWIIWM�"�YWW� WWW I�YII �u �IiIWNNPdWB,� o�vl✓»�,K,SYdbti�reYN3Y/al SITYYl11=11111 i ;;;rMP2�.:.�..S+FJL' "�.r- rv.W"Vd"AN1Y0S.(V":4INI&FM'6R3Yr131. drAY'VYi lF �Y�MkittJE0211 <br />.�........ .ee...wm mm.. �.,.. ....... w. .......... <br />Required Prior to Submittal to Board <br />...................... ..m.. __ <br />Legal ,.��._m�....... __ �....._.�m � . <br />Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controllerand greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the A <br />LJ Agreement <br />Professional Services <br />El Bid Opening <br />Quote Opening <br />[� Chg Order No. <br />Ease./Encroach. <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Michael Schmidt <br />wropriate Item Tyme_- <br />(� Contract <br />( Amendment <br />Bid Award <br />Quote Award <br />El C/O & PCA No. <br />E) Traffic Control <br />forAll Submissions ........................m.................................................... �....___ <br />Proposal (l Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />® Resolution ' <br />n Claim <br />uired Information <br />LJ Yes U If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE F-] No <br />Obsolete Auction Items <br />r r��I$ `. <br />Amount of 0 Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: _.. /o <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: _ <br />... Dispersal <br />..._._...._ ........._........... <br />p After Approval <br />Copy Original <br />® ❑ Jeff Hudak & Donna Hardy <br />