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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />07/05/2016 <br />Hanako Parkhill <br />Department Public Works <br />BPW Date 07/12/2016 Phone Extension 5961 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract <br />❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ <br />Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />® Quote Award <br />❑ <br />Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />❑ <br />Other: <br />❑ Claim <br />Required Information <br />Company or Vendor Name <br />Acorn Landscaping LLC <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Yes <br />No <br />MBE <br />Approved by Purchasing <br />Completed E-Verify Form Attached El Yes <br />" WBE ❑ No <br />2016 Downspout Disconnect Program <br />115-098 <br />Wastewater Other Contractuals <br />641-0630-793-6335 <br />$ 48,355.00 <br />Award quote <br />Regular meeting. <br />For Chan( <br />Amount of H Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />PO No. <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />of 180 calendar <br />the 2016 Downspout Disconnect Program at the <br />Dispersal After Approval <br />Hanako Parkhill <br />Toy Villa <br />Carol Kurzhal <br />