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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1 /21 /20 <br />Name Sue Ellen Doudrick <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date 1/28/20 Phone Extension 5992 <br />MM <br />. . ..... ............ __­__.__ .......... ............... . . . . .... <br />_J�,qquired Prior to Submittal to Board <br />............. ......... — . ...... . .................... . . . ........... <br />Legal Attorney Name: Clara McDaniels <br />Controller El 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 Michael Schmidt <br />Check the A <br />......... .. — - E -------- — Agreement Amendment <br />E] Professional Services <br />FBid Opening <br />F-1 Quote Opening <br />El Change Order No. <br />F-] Ease/Encroach. <br />FOther: <br />. . . ............... <br />Company or Vendor Name <br />ropriate Item <br />L Contract <br />E] Resolution <br />F1 Bid Award <br />F-1 Quote Award <br />0 C/O & PCA No <br />F-1 Traffic Control: <br />New Vendor <br />MBENVBE 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 />- Required for All Submissions <br />0 Proposal <br />F1 Req. to Advertise <br />Required Information <br />F-1 PCA <br />Addendum <br />F-1 Title Sheet <br />SmithGroup JJR <br />El Yes 0 No ----------- [If Yes, Approved `'—by <br />PurchasL'nl..__..__, <br />F1 MBE F-1 WBE <br />No I I Yes Name of Co <br />Seitz Park Reconstruction <br />117-093 <br />... ......... <br />Parks Bond <br />471-1141-452.31-06 <br />$66-,�500 <br />. . . . . . .......... ............. <br />HNTE . <br />------ — - J-6-i- ..... . . . ............ <br />Construction Administration for Seitz Park Reconstruction Phase <br />I <br />L_J Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />..... . ........ For ChanqeOrde�rsOnlv <br />E] increase <br />Amount of [:1 Decrease <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Chance: mm mm % <br />Disoersal After <br />Copy <br />Original <br />F� <br />El <br />F-1 <br />El <br />F <br />El <br />