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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/3/2019 <br />Name Sue Ellen Doudrick <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date 09/10/19 Phone Extension 9246 <br />._..._.... ...t <br />Board Required Prior to Submittal t o mmm,ITmm _..:: <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 <br />Check the A <br />Agreement Amendment <br />E] Professional Services <br />F-] Bid Opening <br />R Quote Opening <br />E] Change Order No. <br />F] Ease/Encroach. <br />F Other: <br />Company or Vendor Name <br />r ropriate Item T re <br />El Contract <br />El Resolution <br />❑ Bid Award <br />Quote Award <br />]C/O &PCANo, <br />_ <br />[ Traffic Control: <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 />Terms of Contract <br />Purpose/Description <br />for All Submissions <br />] Proposal <br />❑ Req. to Advertise <br />Required Information <br />F PCA <br />Addendum <br />❑ Title Sheet <br />Danch, Harner„ & Associates <br />[-] Yes Z No If Yes, Approved by <br />Purchasing <br />El MBE D WBE <br />❑ No E] Yes Name of Company <br />....._....... <br />Small Drainaae Design and Repair <br />. ............... <br />118-063 <br />Lump Sum <br />Overlook Court Design and Construction Documents to resolve <br />two drainage issues. <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />