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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 5, 2019 <br />Name Andrew Netter <br />Department DCI <br />Division/Bureau Plannin <br />g <br />BPW Date 11/12/2019 Phone Extension 5931 <br />�nNnHr�e�-�ua��nua�e�rruru�m�.miuiuwwuwwuw�wiwlluiWuiuuu�ran�����.m�w� rrrrr�ar��m.....�.r.,z�,�zura:�y�uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuumr��w�r� �wnawy �r.�ww,�:�arr�a�uimv�aw;�aaa��r�u� `` �u <br />red Prior to Submittal -- Board <br />.. <br />���._..... �.... ..._.___. .......� <br />Legal ® Attorney Name: Clara McDaniels <br />Controller F] 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 El <br />.......... <br />Check the, <br />L Agreement Amendment <br />0' Professional Services <br />Bid Opening <br />El Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />wropriatq Item Type- <br />Contract <br />Resolution <br />for All Submissions <br />........... <br />Proposal <br />El Bid Award Req. to Advertise <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control: <br />Required Information <br />Addendum <br />❑ Title Sheet <br />�n.......� 0 o...._El If Yes, Approved . �� <br />Yes N by <br />New Vendor Purchasing <br />[� .. _ A,,. _...... <br />MBE/WBE Contractor MBE � WBE <br />MBE/WBE Contractor Requested <br />q No Yes Name of Company <br />Project Name Resolution Declaring the Iy Tech Modular Buil,dincgs Valueless <br />Project Number <br />_,m, m....,,... <br />Funding Source <br />Account No. <br />_......_,... ............ -- <br />Amount <br />Terms of Contract <br />Purpose/Description For the eventual purpose of donating and disposing _.... m.. <br />osin of the ............................................ <br />modular buildings. The City wishes to declare the these modular <br />buildings valueles�c s,.�Required Contractor's Certification Forms Attached (Non..- <br />._... <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Ike quir dw_For.Phanqe Orders Q l .._ .. .. ..mm mm......� <br />Amount of Increase $__. <br />------ <br />El <br />Decrease $ <br />