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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/13/2017 <br />Name Amy Shirk, Senior Budget Analy� Department <br />-Admin & Finance <br />BPW Date 12/21/2017 P hone Extension 9133 <br />Legal F-1 Attorney Name <br />Controller Controller review i's required for all Contracts $5,000.010 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />H Agreement ontract LJ Proposal L-1 Addendum <br />r <br />F-1 Professional Services 4'�Resolution r, <br />F-1 Bid Opening Bid Award Req. to Advertise [J Title Sheet <br />F-1 Quote Opening n Quote Award <br />0 Change Order No. El C/O & PCA No. F] PCA <br />F] Ease/Encroach. F-1 Traffic Control <br />M Other: Disposals <br />Company or Vendor Name <br />New Vendor <br />Yes [:] No If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />MBE [:] WBE <br />MBE/WBE Contractor Requested <br />E] No F-1 Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Requ�ired Contractor's Certification Form Attached (Non - <br />Collusion, N on-Discrim i nation, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F-1 increase $ <br />0 Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original! <br />0 El <br />F] R <br />El El <br />