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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/31/2019 <br />Department Admin & <br />Finance/Central <br />Name Maricela Juarez Services <br />BPW Date 11/12/19 Phone Extension 9953 <br />Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing E] <br />Check the .4 <br />L_J Agreement <br />F-1 Professional Services <br />E] Bid Opening <br />F] Quote Opening <br />EJ Chg Order No. <br />F-1 Ease./Encroach, <br />N' Other: Disnosall <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />)ropriate Item Tvpe — <br />Contract <br />El Amendment <br />El Bid Award <br />F-1 Quote Award <br />F-1 C/O & PCA No. <br />F-1 Traffic Control <br />for All Submissions <br />Proposal <br />El Req. to Advertise <br />ired Information <br />❑ PCA <br />❑ Resolution <br />Claim <br />Addendum <br />El Title Sheet <br />pproved by Purchasing Yes ... ...... ... ....... . ...... . . . ...... . . <br />F-1 No <br />MBE Completed E-Verify Form Attached El Yes <br />WBE [J No <br />For �r��IT� Orders Or�ly <br />Amount of Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />.......... <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />0 <br />El <br />El <br />El <br />1.1 <br />El <br />