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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date April 17, 2018 <br />Department Public Works <br />Name Tara Weigand Division/Bureau Engineering <br />BPW Date April 24, 2018 Phone Extension 5998 <br />Legal F] Attorney Name: <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 ❑ <br />H Agreement Amendment <br />❑ Professional Services <br />❑ Bid Opening <br />F-1 Quote Opening <br />El Change Order No. <br />R Ease/Encroach, <br />F] Other: <br />Company or Vendor Name <br />Contract <br />Resolution <br />Bid Award <br />El Quote Award <br />FI: C/O & PCA No. <br />F-1 Traffic Control: <br />New Vendor <br />MBENVBE Contractor <br />MBE/BE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />OW760M., I <br />0 <br />XM <br />El Yes El No El If Yes, Approved by <br />Purchasing <br />0 MBE F-1 WBE <br />F-1 No 0 Yes Name of Company <br />2018 Curb and Sidewalk <br />118-007 <br />MVH <br />F.Aro•10 <br />Account No. 202-0619-431.31-06 <br />Amount <br />Terms of Contract Unit Prices <br />Purpose/Description Request to Advertise for replacement Curb and Sidewalk at <br />various locations within the city; A3 'S'lq 1 45-10 <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />required r P,,,h' Pqr rs"'Ooly'' <br />Amount of F-1 increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: % W ,,-5 ,A <br />Dispersal After. Approval <br />Copy Original <br />F-1 Kara Boyles, City Engineer <br />23 El Marcia Qualls <br />M F-1 Tara Weigand <br />