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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/05/16 <br />Name Toy Villa Department Engineering <br />BPW Date 07/12/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ❑ 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 ❑ <br />I Check the Appropriate Item Type — Required forAH Submissions <br />❑ <br />❑ <br />Agreement <br />Professional Services <br />® Contract ❑ Proposal ❑ Addendum <br />❑ Resolution <br />❑ <br />❑ <br />Bid Opening <br />Quote Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Requ <br />DLZ <br />❑ No ❑ Yes Name of Comoanv <br />iviarnon Notei Site Uevelopment at Hall of Fame, Ph 1 <br />116-021 <br />RWDA TIF <br />Inspection Services <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc <br />I Required For Change Orders Only <br />Amount of ❑ Increase $ 0.00 <br />❑ Decrease $ <br />Previous Amount $ 0.00 <br />Current Percent of Change: 0.00% <br />New Amount $0.00 <br />Total Percent of Change: 0.00% <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />❑ <br />11 <br />Tim Corcoran <br />Aaron Kobb <br />MIM <br />After Approval <br />