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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />08/12/2016 <br />Kieran Fahey Department Engineering <br />BPW Date 08/23/2016 Phone Extension 5993 <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 <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />® Other: Approval for <br />certain documents and <br />procedures related to the <br />Mandatory Downspout <br />Company or Vendor Name: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requ <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />fired Information <br />Mandatory Downspout Disconnect Program <br />115-098 <br />N/A <br />N/A <br />$0 <br />N/A <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />For Change Orders <br />Dispersal After Approval <br />