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BOARD 4}F PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/6/2018 <br />Department PW <br />Name Sue Ellen Doudrick <br />Division/Bureau Engineering <br />BPW Date 2/13/201 g <br />Phone Extension 5922 <br />Required Prig to Submittal to Board <br />Legal <br />Attorney Name: Clara Mclaniels <br />Controller ❑ <br />Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing IPolicy <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Required for All , Submissions <br />❑ Agreement Amendment <br />0 Contract Ll Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />[:1 Bid Opening <br />El Bid Award ❑ Req. to Advertise [J Title Sheet <br />Quote Opening <br />El Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />® Ease/Encroach. <br />❑ Traffic Control: <br />M Other: Release of Reserve Easements <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE 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 />❑ Yes ❑ No El If Yes, Approved by <br />Purchasing <br />❑ MBE WBE <br />F— No n Yes Name of Company <br />Request BPW to acknowledge release of reserve easement for <br />the Eddy Street Phase II development; reserve easements are <br />recommended to be released for the east/west & north/south 12' <br />vacated alley east of Eddy Street b/n Howard & St. Vincent Sts <br />F] Required Contractor's Certification Forms Attached (Nlon- <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑I Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />El <br />$ <br />Sue Ellen Doudrick <br />Clara Mclaniels <br />