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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11 /5/2019 <br />Silveus <br />Department Engineering <br />BPW Date 11/12/2019 Phone Extension 9083 <br />uired;Prior to. Suornittal to Board <br />Legal EJ Attorney Name Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />H Agreement <br />E] Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Other: <br />❑ Michael Schmidt <br />L J Contract <br />F] Resolution <br />❑ Bid Award <br />Quote Award <br />❑' C/O & PCA No. <br />❑ Traffic Control <br />Proposal <br />® Req. to Advertise <br />❑ PCA <br />Company or Vendor Name TBD <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBENVBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Gemini at Colfax Exterior Renovations <br />Project Number <br />119-103 <br />Funding Source <br />�_ ......_ ............ .... <br />Account No.......... <br />- <br />Amount <br />$ TBD _.... <br />Terms of Contract <br />._ ........ ................ <br />Base bid <br />Purpose/Description <br />Mason Stai '' <br />'r and Roof Re airs of the Colfax Builc <br />Addendum <br />® Title Sheet <br />LJ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of Increase $ <br />�] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />C] <br />❑ <br />EJ <br />❑ <br />