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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />August 6, 2018 <br />Andrew Netter <br />Department <br />Division/Bureau <br />DCI <br />Planning <br />BPW Date August 14, 2018 Phone Extension 5931 <br />_J Agreement Amendment <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />U Contract <br />❑ Resolution <br />® Bid Award <br />0 Quote Award <br />❑ C/O &PCANo <br />❑ Traffic Control: <br />44. I'm %e r <br />❑ Yes ❑ No <br />Purchasing <br />n MBE F-1 WBE <br />0 <br />MBEIWBE Contractor Requested H No LJ Yes Name of <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Proposal L] Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />film <br />If Yes, Approved by <br />Award Bid & Sian Purchase Aareement —1129 N. Lawrence St. <br />III) Z2 S . oo <br />Request to award bid to Kimberly Bloch (sole bidder). Bid <br />amount submitted: $13,225.00. 1129 N. Lawrence St. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />