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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Sue Ellen Doudrick <br />Department <br />Division/Bureau <br />gsmaw <br />Engineering <br />BPW Date 4/10/2018 Phone Extension 5922 <br />Required Prior to Submittal to Board <br />Legal Z Attorney Name: Clara McDaniels <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 />N Agreement <br />H Contract n Proposal El Addendum <br />❑ Professional Services <br />n Resolution <br />Bid Opening <br />El <br />Bid Award D Req. to Advertise El Title Sheet <br />El <br />Quote Opening <br />E] <br />Quote Award <br />F-1 Change Order No. <br />El C/O & PCA Nov F-1 PCA <br />n Ease/Encroach. <br />❑ Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of II <br />I <br />L-e� <br />Christopher Burk <br />LJ Yes LJ No <br />Purchasing <br />H MBE 0 WBE <br />No L] Yes Name of Corrif <br />East Race Sewer Analysis <br />118-034 <br />River East TIF <br />HNTE <br />If Yes, Approved by <br />Analyzing existing sewer system and identifying capacity issues <br />of sewer as a result of future development in the, area bounded <br />by St. Joe River, Niles Ave, LaSalle Ave, and Seitz Park <br />E] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />Z <br />F-1 <br />F1 <br />F] <br />F1 <br />El <br />Sue Ellen Doudrick, Assistant City Engineer <br />