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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/19 <br />Name Kyle..Silveus Department En ineeringmmm mmmm mmm__ <br />BPW Date 10/22/19 Phone Extension 9083 <br />mmmmmmmmmmmmmmmmmmmmmm mI <br />Reauired Prior to Submittal to Board <br />Legal F-1 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 F] Michael Schmidt <br />unecK the <br />Agreement <br />E] Professional Services <br />Bid Opening <br />❑' Quote Opening <br />Change Order No. <br />] Ease/Encroach. <br />E] Other: <br />LJ Contract <br />n Resolution <br />D Bid Award <br />❑I Quote Award <br />❑I C/O & PCA No. <br />F ' Traffic Control <br />Company or Vendor Name N/A <br />Proposal <br />® Req. to Advertise <br />r Addendum <br />4Title Sheet <br />New Vendor 0 Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor E] MBE F] WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Two-1m1Way Conversion of Colfax Ave. — Phase II <br />Project Number m5-053B <br />Funding Source West WashwincitownwwwDevelopment Area TIF <br />Account No. 422-1W050-460-42-03 <br />Amount....�.._N/A.........._... ............................... ......._ .. <br />Terms of Contract <br />Purpose/DescriptionRequired Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of F-1 Increase $ <br />Decrease $..._ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chan <br />Copy <br />Original <br />