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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date September 11, 2019 <br />Name Roger Nawrot <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date September 24, 2019 Phone Extension 5932 <br />s mamwm Mu.rcrmermmummwammr u�w�mmrmuu�rmmrmwimwwuwwwwwmvrsr�m �wu; �i wwwi �w� - may ,MMEMP MMM imi ,,... <br />, NM <br />Legal ❑ <br />Attorney Name: Clara McDaniels <br />Controller ❑ <br />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 El <br />Check the A ro riate Item Type Required for All <br />pp p I Submissions <br />Agreement <br />Contract ❑ Prop �_.... _._ ._ ❑� Addendum <br />osal <br />❑ Professional Services <br />Resolution <br />Bid Opening <br />El <br />Bid Award Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />El <br />Quote Award <br />Change Order No. <br />El <br />C/O & PCA No. F PCA <br />Ease/Encroach. <br />El Traffic Control: <br />Other: Amendment #1 <br />mmw„a <br />R uired Information <br />� �..._..�_ �.� �m..� �_....ww�.�.....� <br />Company or Vendor Name <br />p y <br />Jones <br />_...a s Petrie Rafinski Corporation <br />El Yes Z No If Yes, Approved by <br />New Vendor <br />Purchasi <br />._. a — e <br />MBE/WBE Contractor <br />❑] <br />MBE WBE <br />MBE/WBE Contractor Requested <br />q <br />[� <br />No of Com ;o <br />�] Yes Name <br />Project Name <br />t <br />On -Call Land Survevi <br />n.a/Ri h� t_of_Wa� Services,... <br />Project Number <br />��..w .........._ <br />118-065 <br />Funding Source <br />Professional Services <br />Account No. <br />101-0602-431.3-�� 1-06 <br />Amount <br />$6,000.00......Total Amount... s_$16,000.00.............. .___- �_ <br />Terms of Contract <br />Not to Exceed <br />Purpose/Description <br />LJ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />... <br />a,� �uireo For Change Orders Only <br />Increase ....$ ..._ . <br />Amount of ❑ .� <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change <br />Dispersal After Atorova I <br />Copy <br />Original <br />❑ <br />El <br />El <br />E <br />El <br />