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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />07/19/16 <br />Corbitt Kerr <br />Department Public Works <br />BPW Date 07/26/16 Phone Extension 5896 <br />I Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller El greater <br />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 ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />F- Other: <br />Company or Vendor Name <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 />Information <br />] Yes ❑ No ❑ If Yes, Approved by Purchasing <br />] MBE ❑ WBE <br />Demolition of Vacant & Abandoned Houses, Phase IX <br />116-074 <br />COIT <br />404,1201.415.39.87 <br />Advertise: 7/29 & 8/5, Open: 8/18, Award 8/23 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination Non -Debarment E-Verify,Iran etc <br />Required For Change Orders Onlv <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />,,GardElizabeth Maradik rd of Pubtie Works <br />