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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/08/2018 <br />Name Amy Shirk Department <br />Admin & Finance <br />BPW Date Phone Extension 9133 <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.010 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />LJ Agreement H Contract H Proposal ❑ Addendum <br />F] Professional Services 0 Amendment <br />R Bid Opening El Bid Award [J Req. to Advertise F-1 Title Sheet <br />El Quote Opening F-1 Quote Award <br />Chg Order No. F-1 C/O & RCA No. F-1 PCIA, <br />Ease./Encroach. F-1 Traffic Control *Resolution <br />Other: Disoosal n Claim <br />Company or Vendor Name <br />New Vendor <br />MBEMBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />El Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE F-1 WBE [:] ��s <br />Completed E-Verify Form Attached El <br />Amount of F] increase $ <br />iF] 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 />0 <br />F-1 <br />El <br />El <br />