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BOARD OF PUBLIC WORK'S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 14 June 2018 <br />Name Amy Kryston <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 26 June 2018 Phone Extension 9246 <br />PrierR aired to Submittal to Board, <br />Legal Z 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 />Ll <br />Agreement Amendment <br />H Contract L]'Proposal 0 Addendum <br />F-1 <br />Professional Services <br />n Resolution <br />❑ Bid Opening <br />El <br />Bid Award Z Req. to Advertise E] Title Sheet <br />❑ Quote Opening <br />El <br />Quote Award <br />❑ <br />Change Order No. <br />n <br />C/O & PCA No. ❑ PCA <br />Ease/Encroach, <br />❑ Traffic Control: <br />Other: <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 />Purposeffiescription <br />Ll Yes N No ❑ If Yes, Approved by <br />Purchasing <br />E] MBE [-] WBE <br />n No E] Yes Name of Company <br />North Station Well #1 Replacement <br />t5061r+ for engineer!pq_purposes: 118-0i1).... <br />Water Works Construction Engineering <br />622.0640,661.31.02 <br />Advertise for bidding for the replacement of Well #1 at North <br />Station Well <br />El Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of F1 increase $ *PFU01111) <br />E] Decrease $ ptddiu Works <br />Previous Amount $ <br />Current Percent of Change: % 4X-2-1 18 <br />New Amount $ <br />Total Percent of Change: % <br />arealDig After Approval <br />Copy Original <br />Kyle Silveus <br />Amy Kryston <br />El <br />El <br />