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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 6. 2016 <br />Name Sarah Heintzelman Department Comm Inv <br />BPW Date December 13, 2016 Phone Extension 5842 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ® Contract ❑ Proposal ❑ Addendum <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Chg Order No. <br />Ease./Encroach <br />Other: <br />Company or <br />New Vendor <br />Name <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />❑ Req. to Advertise ❑ Title Sheet <br />Information <br />❑ PCA <br />Resolution <br />Claim <br />Terry Stokes <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Workforce Development Program Coordinator <br />EDIT <br />408-1001-460-31.06 <br />$ 80,0000 <br />Coordination of workforce efforts to maintain a single point of <br />contact for organization and recruitment. <br />For Change Orders Only <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />® Sarah Heintzelman, Community Investment <br />® Brian Pawlowski, Community Investment <br />® Judy Love, Community Investment <br />