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BOARD, OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />09/25/2018 <br />Amv Shirk <br />Department Admin & Finance <br />BPW Date 1 0/09/2018 Phone Extension 9,133 <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,0001.00 or more <br />Controller F] and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing []' <br />L Agreement L Contract Ll Proposal L Addendum <br />F-1 Professional Services El Amendment <br />F] Bid Opening F-1 Bid Award F-1 Req. to Advertise F-1 Title Sheet <br />F-1 Quote Opening F-1 Quote Award <br />F] Chg Order No. El C/O & PCA No. YA <br />El Ease./Encroach. El Traffic Control Resolution <br />MI Other: Disoosal Claim <br />Company or Vendor Name <br />El Yes [:1 If Yes, Approved by Purchasing <br />New Vendor <br />F-1 No <br />F-1 MBE El Yes <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />,MBEEl N <br />F-1 o <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />For Change Orders Only <br />Amount of F1 increase $ <br />El 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 />F-1 F-1 <br />F] F] <br />El El <br />