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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/3/2019 <br />Name Kyle Silveus 6 Department En ineerin <br />BPW Date 9/10/2019 Phone Extension 9083 <br />Pom ON <br />i eauired 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 anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Michael Schmidt <br />Check the <br />LJ Agreement <br />F] Professional Services <br />[� Bid Opening <br />Quote Opening <br />�] Change Order No. _ <br />Ease/Encroach. <br />Other: Reiect Bids <br />Company or Vendor Name <br />bro riate Item Type Required for All Submissions <br />_uu <br />0 Contract El Proposal ❑ Addendum <br />F-1 Resolution <br />E Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Award <br />C/O & PCA No. ❑ PCA <br />[� Traffic Control <br />Required Information <br />New Vendor ❑ Yes 0 No 0 If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Drewry Brewery. Cl.e.anup. ____ <br />Project Number 119-031 A <br />Funding Source <br />_ .............................................. .......... ......... ........................................... .......... <br />..w <br />Account No. <br />Amount $ N/A ._._.................. <br />................ ...... mmaaa.� <br />Terms of Contract <br />Purpose/Description Cleanup,of Drew 's Brewe Demolition Debris <br />El Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc. <br />Amount of ❑ Increase $ <br />1-1 Decrease . $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount ................... <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />0 <br />