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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />November 14. 2016 <br />David Relos <br />Department DCI <br />BPW Date November 22, 2016 Phone Extension 5836 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Ben Dougherty <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 />I-1 Other: <br />Company or <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Redevelopment <br />J Yes 1J No 1J If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />Engineering Services Agreement <br />RDC approved at their 11/10 meeting. <br />RDC to pay for two engineers dedicated to redevelopment projects. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination_ Non-rneharmanf F-Varifv Iran A+r <br />ired For Change Orders <br />Amount of I 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 />E <br />® <br />❑ <br />® <br />❑ <br />Ben <br />Relos <br />Dispersal After Approval <br />