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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/14/2019 <br />Name Adam Parsons <br />Department Central Services <br />Division/Bureau <br />BPW Date 10/22/2019 Phone Extension 9302 <br />�^w�uu�wr�rrra� ����w�wuuuuumrrd� i�ivrc���A�%ri,�rres:as�r�rr� �---�m.o�;wrw r,�umra-=�+�,.,,A.�,„,���.�u,,,,ru,�uuuuuuuuuumuw�niomir�rviwm ......raw��uuuurmau�,^a�ur�aamarr�mrammrrerrrrnrasw�rnnrc�wr��er <br />11 <br />.................. _ .. �___. f'�red Prior to Submittal to Board..........mmm w <br />Legal ® Attorney Name: Clara McDaniels <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 ❑ <br />Check the <br />L Agreement Amendment <br />El Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />F1 Ease/Encroach. <br />F] Other: <br />iror All opriate <br />Contracm..........y[?e_—_ReWired❑fProposalLjvj�.mm_.......___m..� <br />Resolution <br />Bid Award ® Req. to Advertise <br />Quote Award <br />C/O & PCA No. ❑ PCA <br />Ej Traffic Control: <br />'"' � • � rw �r � ,� <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name TBD <br />❑ Yes ❑ No El If Yes, Approved by <br />New Vendor Purchasing mmmmmmwwwwwwww <br />MBE/WBE Contractor E] MBE ❑ WBE .........._.. <br />MBE/WBE Contractor Requested No ❑ Yes .Name of Company__- <br />. . ................ <br />.a. <br />Project Name City -Wide Overhead Door Contract <br />Project Number <br />Funding Source Department Building Maintenance Budgetsmm _..... w <br />Account No. Various ......._._ <br />............ _._ .................w.... <br />Amount TBD <br />Terms of Contract 2 gear initial contract; 2 year renewal <br />Purpose/Description Standardize city facility overhead door repairs Wunder one <br />co <br />ntractor <br />� <br />�............_......- <br />Required Contractor's Certification <br />ui <br />q � Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />. ]m crease oir d For Change Orders,_ a �y <br />In _._,.. ....._._ _�.....�.v�,... <br />Amountof $� �....................w, _........�.........m� .._ . <br />E] Decrease $ <br />Previous Amount $ ......... -t:�. <br />Current Percent of Change: ........... %W <br />New Amount $ <br />Total Percent of Chanee: <br />Dispersal After Aooroval <br />Copy <br />Original <br />F <br />