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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />11 /10/2016 <br />Richard Estes <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 11/22/2016 Phone Extension 5896 <br />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 Aii 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: <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 />u <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />U MBE U WBE <br />❑ No ❑ Yes Name of Company <br />Newman Center Roof Repair <br />116-131 <br />Repair of the Newman Center Roof. Proposed schedule: Ad1- <br />11/25, Ad2-12/2, Bids Due 12/13, Bid Award 12/13 <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />zli <br />Current Percent of Change: % card A M <br />New Amount $ worKs <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Patrick C Kerr <br />® ❑ Aaron Kobb- <br />❑ 7 -- <br />