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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />October 4, 2018 <br />Ron O'Connor <br />Department Code Enforcement <br />BPW Date October 23, 2018 Phone Extension 9294 <br />Re ujred Prior o, Submittal to Board <br />Legal X Attorney Name Kennedy <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller X and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing, X <br />X Agreement H Contract LJ Proposal L] Addendum <br />n Professional Services 7 Amendment <br />Fj Bid Opening El Bid Award ❑ Req. to Advertise El Title Sheet <br />Quote Opening El Quote Award <br />❑ Clog Order No. C/O & PCA No. PCA <br />❑ Ease,/Encroach. ❑ Traffic Control ❑ Resolution <br />n Other: F1 Claim <br />I Required Information <br />Company or Vendor Name IUSI3 <br />F-1 Yes E] If Yes, Approved by Purchasing <br />New Vendor <br />X No <br />El Ye <br />7 MBE <br />MBEIWBE Contractor <br />El Completed E-Verify Form Attached <br />F� WBNos <br />Project Name <br />Wooden Indian Demolition <br />Project Number <br />N/A <br />Funding Source <br />EDIT <br />Account No. <br />408-1201-415-39M <br />Amount <br />$50,000 <br />Terms of Contract <br />December 31 2018 <br />Purpose/Description <br />Contribution to the demolition of 1631 Lincoln Way East also, <br />known as the Wooden Indian MV otel. <br />I;or Chane Orders Only <br />Amount of El <br />increase $ <br />F-1 <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change' % <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />El X <br />Ron O'Connor <br />X R <br />'Tim Corcoran <br />El El <br />