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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />7/5/2016 <br />Public Works <br />Engineering <br />BPW Date 7/12/2016 Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <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 ❑ 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 />® Other: Amendment to Award Memo <br />Richard Estes <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 />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />Copy <br />Origin <br />® <br />❑ <br />Department <br />Division/Bureau <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />LJ MBE H WBE <br />❑ No LJ Yes Name of Company <br />Marriott Hotel Site Development at Hall of Fame Phase I <br />324-1050-460-3102 <br />Collusion <br />Patrick C. Kerr <br />EMS <br />red Contractor's Certification Forms Attached (Non - <br />Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />For Change Orders On <br />