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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />08/22/2019 <br />Patrick Sherman <br />Department VPA: F&G <br />BPW Date 08/27/2019 Phone Extension 5601 <br />w� wireamr�iioimuww�wwmrwwa m� nuro�irawA� a murr�wwNmvwuw......::..�:m��rv�rvmmiwimuuwmw�tmro urr;�iu�i uwm�w�wwn ���rcmr �wum�una��a <br />.Re'Submittal to Board <br />.ired Prior to ......� <br />Legal ® Attorney Name Clara McDaniels <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Michael Schmidt <br />Check the m...... <br />LJ Agreement <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />0 Change Order No. <br />❑ Ease/Encroach. <br />F-1 Other: <br />�roriate Item Tye et <br />Contract <br />Resolution <br />El Bid Award <br />Quote Award <br />El C/O & PCA No, <br />Traffic Control <br />uired Info <br />Company or Vendor Name Custom Fence Com ar <br />for All Submissions <br />Proposal �_�___._.���......... <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor <br />Yes E No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />MBE n WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Kernan Park Drive Gate <br />Project Number <br />J <br />1092-201 �.._ww....__�����.......................�..��...�r__....�A.�...........................-..._ �..�..............................���m..m...mm......_. <br />9 <br />Funding Source <br />Parks Maintenance <br />Account No. <br />.. ..... ..... .......... ___.-.,.�. w <br />201-1101-452.39-89 <br />_�—._.... <br />Amount <br />.... ..� �............. <br />$ 2,604.09 <br />Terms of Contract <br />Lump §um w <br />Purpose/Description <br />New ate for arkin lot entrance at Governor ,Joe Kernan Park <br />® Required Contractor's Certification Form Attached (Non- <br />-_ <br />.... Collusion, Non -Discrimination, Non -Debarment, E-Verity, Iran, etc <br />. g,_..m sOn <br />Re uired For Chan e Order ..._. ...�Y <br />Amount of El <br />Increase $ <br />Decrease $ <br />Previous Amount <br />................ ���...�... ...... <br />$ <br />