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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/19/2018 <br />Name Tony Stearns Department Recreation - Golf <br />BPW Date 4/24/2018 Phone Extension 6500 <br />Legal X <br />Attorney Name Clara McDanieIs <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ <br />and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing Z <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />F1 Agreement <br />Z Contract El Proposal <br />❑ Addendum <br />F Professional Services <br />F Amendment <br />F-1 Bid Opening <br />F Bid Award El Req. to Advertise <br />❑ Title Sheet <br />El Quote Opening <br />El Quote Award <br />❑ Chg Order No. <br />F-1 C/O & PCA No. PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control ❑ Resolution <br />❑ Other- <br />Claim <br />Required <br />Information <br />Company or Vendor Name <br />Gofflow LLC <br />New Vendor <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />No <br />MBEIWBE Contractor <br />❑ MBE Completed E-Verify Form Attached <br />F WBE <br />El Yes <br />El No <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Zero Dollar amount agreement <br />Terms of Contract <br />Purpose/Description <br />For Change Orders Only <br />Amount of F-1 increase $ <br />F Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />z E] Tony Sterns <br />0 Daniel <br />O'Connor <br />EJ 1:1 <br />