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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/30/2019 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />Y _.... �........................66 ._._ <br />BPW Date 10/8/2019 Phone Extension 9083 <br />vwm womi�r "��! 0M mmmuummuwimmmOimmwmo EMMMmmm�m ... m . IN <br />F „ _ squlred Prior to Submittal to Board <br />Legal Attorney Name: Clara McDaniels <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 Michael Schmidt <br />the <br />H Agreement <br />® Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: PSA Amendment <br />TrrMote Ilterr Typ <br />El Contract <br />Resolution <br />❑ Bid Award <br />❑ Quote Award <br />El C/O & PCA No. <br />El 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 />for All Submissions <br />I Proposal Addendum <br />❑ Req. to Advertise <br />❑ PCA <br />❑ Title Sheet <br />quired Information <br />_m_.... <br />Abonmarc_he Consultants, Inc. <br />El ....w _ <br />Yes No If Yes, roved b Purchasing A .. .. ....._ <br />MBE WBE <br />No Yes Name of Company <br />Western Ave. Streetsca e - Phase III <br />118-076 <br />324-1050...460..... _�........_.. .... <br />............. <br />-31-02 <br />Hourly Not to Exceed.Inccreased.... Increased amount for Constructionas <br />ou Pha <br />se <br />Services <br />Ll Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />°�+ir�u�red For%Ch;�O Orders 1 - - <br />Amount of � Increase $ <br />Decrease $ <br />Previous Amount $ <br />...................... <br />Current Percent of Change: % <br />New Amount ................................ �... <br />���.�.�._............................................�___�............................ <br />—....,, <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />El F] <br />