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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/18/2019 <br />Department Public Works <br />Name Kyle Silveus <br />___... .._..._ Division/Bureau Engineering <br />BPW Date 11/26/2019 <br />Phone Extension 9083 <br />........ <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: Clara McDaniels <br />Controller ❑ <br />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 />Michael Schmidt <br />Check the Appropnate Item Type — Required for All Submissions <br />0 Agreement <br />El <br />Contract EJ Proposal EJ Addendum <br />0 <br />Professional Services <br />0 <br />Resolution <br />Bid Opening <br />F-1 <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />El <br />Quote Award <br />Change Order No. <br />El <br />C/O & PCA No, F1 PCA <br />D Ease/Encroach. <br />❑ <br />Traffic Control <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of U Increase <br />F Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Chance: <br />Copy <br />Original <br />❑ <br />❑ <br />egired Information <br />HWC E Bring ...... <br />_.......... proved Puurcmm <br />0 Yes No If Yes„ A roved b Phasi <br />MBE F1 WBE <br />No 0 Yes Name of Comp qy <br />Western Ave Streetscape - Phase III <br />118-076 <br />RWDA TIF <br />324-1050-460-31-02_w� ��.�.�.._ .............�� <br />$9,053.0�0.��...................... � � �......._.. ....................... <br />Hourly, to.........................w�._... <br />y Exceed <br />Construction Inspection Service <br />s,�� <br />L...J Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Dispersal After Approval <br />