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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />JIF-11 <br />Name Patrick Sherman <br />Department VPA-. Facilities & <br />Grounds <br />BPW Date 08/14/2018 Phone Extension 5601 <br />Legal Z Attorney Name Clara McDaniels, <br />Controller Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />n Agreement <br />El Contract H Proposal ❑lAddendum <br />EJ Professional Services <br />F-1 Resolution <br />El Bid Opening <br />F-1 Bid Award El Req. to Advertise ElTitle Sheet <br />F] Quote Opening <br />❑ Quote Award <br />FI Change Order No. <br />❑ C/O & PCA No. PCA <br />F] Ease/Encroach. <br />❑ Traffic Control <br />M Other. CanGe1-Gontr&et <br />h 11 ry"I 4", 4 ( uIvl 1'e 4 C-f' <br />Company or Vendor Name Stone Revival Historical Preservation <br />New Vendor M Yes 0 No E] If Yes, Approved by Purchasing <br />MBEMBE Contractor ❑ MBE F-1 WBE <br />MBEANBE Contractor Requested F-1 No F-1 Yes Name of Company <br />Project Name - City Cemetery Headstone Repairs <br />Project Number 1068-2018 <br />Funding Source - Facilities and Grounds Maintenance <br />Account No. 201-1101-452.36-09 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />$ $165 per repair, $145 per reset <br />Fixed fee oer monument: 67 monuments more or less: <br />Co <br />) meet the terms of the ai <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Amount of El Increase <br />E] Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />El <br />F-1 <br />F] <br />F] <br />R <br />El <br />