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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/17/2019 <br />Name Patrick Sherman <br />Department VPA <br />BPW Date 10/22/2019 Phone Extension 5601 <br />ai i�rwww�w�mmmum.mmmwwvwMw � � imuwimu�wwuerc�mr�n �� mmamimar�w.m�ar�u�u�.... � urnummu �mi�u <br />�,,,,w, IT�ITmmmm_m .. Required Prior to Submittalm_tomm_Boardww <br />Legal ® Attorney Name Clara McDaniels <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Michael Schmidt <br />Check the <br />Agreement <br />�] Professional Services <br />Bid Opening <br />j Quote Opening <br />Change Order No. <br />❑ Ease/Encroach. <br />Other: Reject Quote <br />)rriate Item T mmm <br />El Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />El Traffic Control <br />,,e for All Submissions <br />= Proposal El Addendum <br />EJ Req. to Advertise ❑ Title Sheet <br />ired Information <br />❑ PCA <br />Company or Vendor Name <br />TBD <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Byers Orange Field Scoreboard El m ....._. .. <br />cd d ectrical suppmmmmm m <br />Project Number <br />11 00-2019 <br />Funding Source <br />Community Foundation mm..__.._..._._u a .....__ <br />Account No. <br />.............. <br />201-1101-452.36-09 <br />Amount <br />$ N/A n <br />Terms of Contract <br />N/A <br />Purpose/Description <br />Re ect Quote� <br />received for electrical work at Orange Field in B er's <br />Softball Complex because it was over bud et, <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion„ Non -Discrimination, Non -Debarment„ E-Verify, Iran, etc.) <br />luired For Change Orders O <br />Amount of El Increase $ <br />(� Decrease $ <br />Previous Amount $ <br />Current Percent of Change, <br />New Amount $ <br />Total Percent of Change: <br />Aft Dispersal <br />After er Approval <br />Copy <br />Original <br />F] <br />❑ <br />