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BOARD OF PUBIAC WORKS <br />AGENDA ITEM RE, VIEW REQUEST FORM <br />Date June 4, 2018 <br />Name Roger Nawrot <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date June 12, 2018 Phone Extension 5932 <br />Required Prior to Submittal to Board <br />Legal Attorney Name,: Clara McDaniels <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 z <br />Check the Appropriate Item Type — Required for All Submissions <br />E] Agreement n Contract E] Proposal El Addendum <br />Professional Services F1 Resolution <br />Bid Opening 0 Bid Award Z Req. to Advertise M'Title Sheet <br />F-1 Quote Opening 0 Quote Award <br />E] Change Order No. ❑ C/O & PCA No. F] PCA <br />F1 Ease/Encroach. ❑ Traffic Control: <br />F1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />uired Information, <br />El Yes [:] No E] If Yes, Approved by <br />Purchasina <br />[:] No [Ji Yes Name of Company _ <br />Off Site Parking at St Louis Blvd. and Wayne Street <br />117-083B <br />Regional Cities­ <br />20,1-1111-452.31-06 <br />Not to Exceed <br />LJ Required Contractor's Certification Forms Attached (Non,- <br />CoHusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F1 increase $ <br />El Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />$ Of PrL,. <br />% .. , <br />I Dispersal After ADDroval ?A10 I <br />Copy <br />Original <br />F-1 <br />F-1 <br />11 <br />R <br />El <br />F1 <br />