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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />4/18/18 <br />Jitin Kain <br />Department Public Works <br />BPW Date 4/24/18 Phone Extension 5835 <br />® Agreement <br />❑ Contract <br />Lj Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Amendment <br />❑ <br />Bid Opening <br />❑ <br />Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ <br />Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />n <br />Other: <br />n <br />Claim <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor. <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Emily Macellari <br />Yes Ll If Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE ❑ No <br />Graphic Design Services <br />$1,200 <br />Graphic design services for public works brochures, annual report <br />and other marketing and outreach materials. <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />