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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2-19-2020 <br />. .... . . . . ......... . . ........... . . . . . . ............................ <br />Department Utilities- Water <br />Name Bradlev J. VanOosterum Treatment <br />BPW Date 3-10-2020 Phone Extension 5670 <br />�Wffl N NOON M I�4- =-I,- <br />E-1--­- Required Prior t,oSubmittal to Board <br />Legal 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 <br />Check the Ar <br />[:] Agreement <br />E] Professional Services <br />E] Bid Opening <br />0 Quote Opening <br />EJ Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />Multi r)IeVendors <br />po riate Item T rpe..- Regi <br />Contract <br />F] Resolution <br />0 Bid Award <br />F1 Quote Award <br />n C/O & PCA No. <br />E] Traffic Control <br />for All Submissions <br />I Proposal El Addendum <br />Z Req. to Advertise El Title Sheet <br />uired Information <br />F-1 PCA <br />New Vendor El Yes N No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE n WBE <br />MBE/WBE Contractor Requested E] No n Yes Name of Company <br />Project Name Water Treatment Chemicals 2020-2024 <br />Project Number ........... <br />Funding Source <br />Account No. Various Operational Budqets <br />... ........... . . ...... <br />Amount <br />Terms of Contract 4 YEAR <br />Purpose/Description Chemical Bid needed to secure competitive pricirIg <br />n Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verj,fy, Iran, etc.) <br />Repired-For Change Orders OUI . . ............... <br />Amount of increase $ .. .......... . . ................................ . ................. - ----- Decrease <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: . . . ........... . .......... <br />Dispersal After Approval <br />Copy Original <br />M F-� Michael Schmidt <br />M R Bradley J. Van <br />0 n! <br />