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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12-12-2016 <br />Name <br />Santiago Garces <br />Department <br />Innovation <br />BPW Date <br />12-22-16 <br />Phone Extension <br />7652 <br />Legal ® Attorney Name 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 />❑ Agreement L] Contract L] Proposal L] 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 Vendor Name Anna Ker <br />New Vendor ® Yes <br />MBEANBE Contractor ❑ MBE [ <br />MBEAINBE Contractor Requested ❑ No <br />Project Name <br />Project Number <br />Funding Source COIT Fund Professional Services <br />Account No. 404-0672-415-31-06 <br />Amount $ 9,000 <br />Terms of Contract 1/1/2017 — 2/28/2017 <br />Purpose/Description Design Professional Services <br />® Required Contractor's Certification Form Attached (Non - <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ❑ Sant <br />® ❑ Penr <br />® ❑ John <br />io Garces <br />Price <br />No LJ If Yes, Approved by Purchasing <br />WBE <br />Yes Name of Company <br />