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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />February 20, 2018 <br />Department <br />Public Works <br />Name <br />Carl Littrelf <br />Division/Bureau <br />Engineering <br />BPW Date <br />February 27, 2018 <br />Phone Extension <br />9149 <br />Legal JR Attorney Name: Clara McDaniels <br />Controller El 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 F <br />L_J Agreement Amendment U Contract LJ Proposal Ll Addendum <br />F-1 Professional Services F-1 Resolution <br />❑ Bid Opening ❑ Bid Award El Req. to Advertise El Title Sheet <br />F-1 Quote Opening 0 Quote Award <br />El Change Order No. F-1 C/O & PCA No. PCA <br />HEase/Encroach. <br />R Traffic Control: <br />'Other: Release of Easement <br />Company or Vendor Name <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/Desceiption <br />Jack Eugene Clemans Revocable Trust & Darlene Jean <br />Clemans Revocable Trust_ <br />El Yes [:] No El If Yes, Approved by <br />Purchasina <br />E <br />L] No U Yes Name of Company _ <br />New Dollar General Store, — 6103 S. Michiaan Street <br />EM <br />Releases Non -Access Easement to allow full property <br />development <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: <br />Di ersl After Approval <br />Copy Original <br />R F-1 Carl Littrell <br />F1 F-1 <br />