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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 8, 2011 Department C &ED <br />BPW Date June 23, 2011 Phone 235 -5842 <br />Name Bill Schailiol <br />:a Legal ® Attorney Name L. Meteiver <br />(DI o 70, Controller review is required for all Contracts $5,000.00 or more <br />o o Controller ® and greater than one year in length per the City Purchasing <br />n`. m Policy <br />Other Appropriate Reviewers ❑ <br />.Check: the Aon.m rlate Vern Tvne — Pa. au]rad fnr'Ail �tphm %cc1��c <br />Reautred Information <br />Company or Vendor Name <br />A reement <br />Contract <br />Pro posal <br />Addendum <br />Z No <br />Claim <br />If Yes, Approved by Purchasing <br />Project Name <br />Bid Opening <br />❑ <br />Bid Award <br />Funding Source <br />Req. to Advertise <br />Title Sheet <br />Lj <br />Quote Opening <br />$ <br />Quote Award <br />El <br />Chg Order No. <br />Addendum related to 748 Hawbaker Demolition Planning Project <br />C/O & PCA No. <br />❑ <br />PCA <br />Ease. /Encroach, <br />Traffic Control <br />Resolution <br />Lj <br />Other: <br />Reautred Information <br />Company or Vendor Name <br />❑ <br />❑ <br />New Vendor <br />0 <br />Yes <br />Z No <br />0 <br />If Yes, Approved by Purchasing <br />Project Name <br />748 Hawbaker Demolition Planning Project <br />Project Number <br />asst -- t ! I -o Y5 <br />Funding Source <br />SSDA TIF <br />Account No. <br />430 - 1050 -460 -31.06 <br />Amount <br />$ <br />Terms of Contract <br />Purpose /Description <br />Addendum related to 748 Hawbaker Demolition Planning Project <br />Amount of <br />❑ <br />❑ <br />Increase <br />Decrease <br />$ <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Copy Original <br />® ❑ <br />1����ersal �tt+er At3prQ�a1. . <br />Cheryl Phipps, CED <br />Bill Schalliol, CED <br />