Right of Way Dedication - Portage Avenue at Boland Drive Roundabout

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date August 15, 2019 Department Public Works Name RogerT. Nawrot Division/Bureau Engineering BPW Date August 26, 2019 Phone Extension 5932 Required Pdorto Submittal to Board Legal ® Attomey Name: Controller ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one year in length per the City Purchasing Policy Purchasing ❑ Check the Appropriate Item Type- Required for All Submissions ❑ _ Agreement ❑ Contract ❑ Proposal ❑ Addendum ❑ Professional Services ❑ Resolution ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Change Order No. _ ❑ C/O & PGA No. _ ❑ PCA ❑ Ease/Encroach. ❑ Traffic Control: ❑ Other: Right of Way Dedication _R"aired Information Company or Vendor Name ❑ Yes ❑ No ❑ If Yes, Approved by New Vendor Purchasing MBEWBE Contractor ❑ MBE ❑ WBE MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company Project Name Portage Avenue at Boland Drive Roundabout Project Number 118-065 Funding Source Account No. Amount Terms of Contract - ......................................... -- -----------...-........- Purpose/Description Right of Way dedication of City owned land. ❑ Required Contractor's Certification Forms Attached (Non - Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) ....m.._ �,� ...._ �.- RequiradFarChir�eOrdesOnly Amount of ❑ Increase $ _. ............................. .. _ ❑ Decrease $ Previous Amount $..............__... —.............. Current Percent of Change: J New Amount $ - ................_.....-- Total Percent of Change :........................................ _._._._...... - °I Dispersal After Approva.l....._............... Copy Original El El ❑ ❑