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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />16 Aug 2016 <br />Cecil Eastman <br />Department Code Enforcement <br />BPW Date 23 Aug 2016 Phone Extension 9317 <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 ❑ <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: Folder rental <br />Required Information <br />Company or Vendor Name <br />New Vendor ❑ Yes Lx <br />MBE/WBE Contractor ❑ MBE [ <br />MBE/WBE Contractor Requested ❑ No <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 />No ❑ If Yes, Approved by Purchasing <br />j WBE <br />] Yes Name of Company <br />600-1201-415.36-02 <br />1,831.68 <br />5 years <br />Equipment rental <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination Non -Debarment E-Verify, Iran et< <br />Reauired For Chanae Orders Only <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />N <br />❑ <br />❑ <br />❑ <br />❑ <br />Cecil Eastman <br />Approval <br />