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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/20/23 Department Fire <br />BPW Date 2/14/23 Phone 9255 <br />Name Carl Buchanon, Fire Chief <br />o Legal ❑ Attorney Name <br />F Controller review is required for all Contracts $5,000.00 or more <br />.5 ` oo Controller ❑ and greater than one year in length per the City Purchasing <br />IY " - m Policy <br />U) Purchasing ❑ <br />Check the ADDrooriate Item Tvoe — Reauired fnr All Suhmissinns <br />❑ <br />Agreement <br />❑ Contract Proposal ❑Addendum <br />❑ <br />Claim <br />❑ <br />Bid Opening <br />❑ <br />Bid Award <br />❑ Reg. to Advertise <br />❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Chg Order No. <br />❑ <br />C/O & PCA No. <br />❑ <br />PCA <br />❑ <br />Ease./Encroach. <br />❑ <br />Traffic Control <br />® <br />Resolution <br />Other: <br />RACli irAri Infnrmatinn <br />Company or Vendor Name <br />New Vendor <br />❑ <br />Yes ❑ <br />No <br />If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />Ej <br />MBE ❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Dis osal of Unfit Property -Helmet and Boots -Retires: R. Brecht, <br />M. Brown B Dusz nski S. Searfoss S. Vandervort <br />For Change Orders <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />