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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/12/2019 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 09/24/2019 Phone Extension 5920 <br />i^i^emu A,mirr�aauuu w w luau mmimwn°,lomuuuuuuuuuuuuuuummmmmmmm upromnwn <br />.,,,., ,.,�. ._......�.__ .......�p ._.�. w ....�..m..,.,.�._....._...........................�..�.. .................. I e�ui.redmm_Prior to Submittal to Board <br />..................._...... _...._.._.................._.. <br />Legal Attorney Name: <br />Controller El 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 ElCheck the <br />LJ Agreement <br />F-1 Professional Services <br />Bid Opening <br />0 Quote Opening <br />❑ Change Order No.. <br />Ease/Encroach, <br />F-1 Other: <br />Company or Vendor Name <br />�ropriate Item Tie <br />�] Contract <br />Resolution <br />El Bid Award <br />D Quote Award <br />ElC/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 />Amount of Increase <br />Decrease <br />Previous Amount $ <br />Current Percent of Change, % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />for All Submissions <br />I Proposal <br />❑ Req. to Advertise <br />wired Information <br />Brown & Brown General Contractors, Inc. <br />Proiect Closeout <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />,cgtred For n e Orders ONy._........ <br />Dispersal After Approval <br />