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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/13/2019 Department Public Works <br />Name Toy Villa /�%..........................._.....w�w..�.-��...........�...,,.�,,,�.......A...�.�...�.�.........�_ <br />Division/Bureau Engineering <br />BPW Date 09/24/2019......�......._._._..........................................................._�..................�_________.u_. Phone Extension .�...5920.�_�.�.�...�w . <br />I, IIIIIIIIIIIIIIIIIIIIIIIIIIIIIWIIWW�Wi.NqM NNFlW�d ' P I"NM�IV(�l %1%N�PIA�IdYF "WWWWP I'WWM�MP IlM DMi mmlmlmmmmmmmmmllllllllllllllll�t <br />................ .......................,., <br />Required Prior to Submittal to Board <br />... _ .._ _ .. ........ _..�.............. <br />Legal Attorney Name: <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 El <br />Check the <br />LJ Agreement <br />❑ Professional Services <br />E] Bid Opening <br />E] Quote Opening <br />0 Change Order No. _ <br />EJ Ease/Encroach. <br />�7 Other: <br />)ropriate Item Type—_!3eguired for All Submissions <br />❑ Contract [❑ Proposal <br />E] Resolution <br />❑ Bid Award ❑ Req. to Advertise <br />El Quote Award <br />® C/O & PCA No.1 Final ❑ PCA <br />❑ Traffic Control: <br />Company or Vendor Name <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 />Amount of <br />Reauu fired Information <br />Hardman Construction, Inc. <br />Addendum <br />❑ Title Sheet <br />Main and Jefferson Earthwork <br />_..._._........... .... ....... .... .... <br />...... ... ..... <br />119-022 <br />RWDA TIF <br />324.1050.460.42.01 <br />$255,250.00 <br />Proiect Closeout <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment„ E-Verify, Iran, etc. <br />egyufirer j , m mge Orders Ong <br />Increase $ <br />Decrease $ <br />I After <br />