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BOARD OF PUBLIC WORKS <br />AGENDA ITEM RE, VIEW REQUEST' FORM <br />Date 12/06/17 Department <br />Name Toy Villa Division/Bureau <br />Engineering <br />DPW <br />BPW Date 12/12/17 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: <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 El <br />Check the Appropriate Item Type -,Required for All Submissions <br />E] Agreement <br />F1 Contract El Proposal F-1 Addendum <br />F_]I Professional Services <br />Resolution <br />F1 Bid Opening <br />❑ <br />Bid Award Req. to Advertise E] Title Sheet <br />F-1 Quote Opening <br />❑ Quote Award <br />F-1 <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />El <br />Ease/Encroach. <br />❑ Traffic Control, - <br />El <br />Other: <br />Required Information <br />Company or Vendor Name Fuerbringer Landscaping & Design, Inc. <br />New Vendor <br />MBE/WBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />L] Yes N No H If Yes, Approved by <br />Purchasing <br />F1 MBE F-1 WBE <br />❑ No 0 Yes Name of Company D/a <br />2017 Tree Plantings <br />117-009B <br />MVH <br />202.0619.431.31.06 <br />$19,000m <br />Terms of Contract <br />Purpose/Description Project Closeout <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Noin-Discri m i nation, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change-, % <br />New Amount $ <br />Total Percent of Change: <br />rsal After <br />Copy <br />Original <br />❑ <br />R <br />