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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 22, 2017 <br />Name Tara Weigand <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date January 9, 2018 Phone Extension 5998 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: <br />Controller ❑ Controller review lis required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing 1-1 <br />H Agreement Amendment <br />El Professional Services <br />0 Bid Opening <br />F1 Quote Opening <br />F-1 Change Order No. <br />F Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />Contract <br />Resolution <br />Proposal <br />F-1 Bid Award F1 Req. to Advertise ❑ Title Sheet <br />D Quote Award <br />F] C/O & PCA No. F-1 PCA <br />M Traffic Control: Residential Handicap Parking <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />El Yes El No E] If Yes, Approved by <br />Purchasina <br />H MBE LJ WBE <br />FTNo F-1 Yes Name of Comoanv <br />826 N St Louis Boulevard Residential Handicap Parking <br />HI Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase $ <br />E] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Cha <br />Copy Original <br />F1 Roger Nawrot, Assistant City Engineer <br />F] Ed Gleckler, Manager Bureau of Traffic & Lighting <br />N F] SBPD <br />