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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />7/19/2016 <br />Public Works <br />Engineering <br />BPW Date 7/26/2016 Phone Extension 5896 <br />Richard Estes <br />Department <br />Division/Bureau <br />I <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: Michael Schmidt <br />Controller El <br />review is required for all Contracts $5,000.00 or more and <br />greater <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® <br />George King <br />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 ® 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 />❑ <br />Other: <br />Required Information <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 />❑ Yes ❑ No ❑ If Yes, Approved by <br />❑ MBE ❑ WBE <br />_❑ No ❑ Yes Name of Company <br />Chet Waggoner Court <br />116-005 <br />RWDA TIF <br />324-1050-460.31-02 <br />Request Bids for new road off of Dylan Drive between Brick and <br />Adams. Bids Due 8/18, Bid Award 8/23 <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Chanqe Orders <br />Amount of II Increase $ <br />El Decrease $ <br />Previous Amount $ °o+d of <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Chance: % -S� J L Z <br />a <br />Copy <br />Original <br />® <br />❑ <br />