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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/06/2016 Department <br />Richard Estes <br />Public Works <br />Division/Bureau Engineeri <br />BPW Date 12/1312016 Phone Extension 5896 <br />I 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 />I Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract ❑Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ® Req. to Advertise El Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control: <br />F <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 />Amount of H Increase <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae- <br />Copy Original <br />® ❑ Aaron Kobb <br />❑ ❑ <br />Information <br />U Yes LJ No LJ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />❑ No LJ Yes Name of Company <br />Equipment Purchase for Nello Corporation Phase XIII <br />116- <br />River West Development TIF <br />324.1050.460.42.07 <br />Advertisement for the purchase of welding machines for Nello <br />Corporation. First Ad 12/16, Second Ad 12/23, Open Bids 01/10 <br />Required Contractor's on - <br />Certification Forms Attached (N <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Change Orders <br />After Approval __. � -(.I 1 /,z <br />