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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/23/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />.... . ....... . <br />BPW Date 11/13/2018 Phone Extension 5920 <br />Rp1i:,.:Iujred Prior to Submittal to Board <br />. ......... ... . .... . . ........... <br />Legal E] Attorney Name. - <br />Controller ❑ <br />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 1:1 <br />Agreement Amendment <br />Professional Services <br />E] Bid Opening <br />F1 Quote Opening <br />Change Order No. <br />❑ Ease/Encroach. <br />F1 Other: <br />LJ Contract <br />Resolution <br />Bid Award <br />F] Quote Award <br />❑C/O & PCA No <br />Traffic Control: <br />................ <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />ect Closeout <br />Proposal LJ Addendum <br />F-1 Req. to Advertise E] Title Sheet <br />Z PCA <br />n <br />E:1 Required Contractor's Certification Forms Attached (Non- <br />_.C.211,usion, No n-Discrim i nation, Non -Debarment, E-Verity,Iran, etc. <br />Required For Chancie Orders OnIv <br />Amount of Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Chance: % <br />Copy Original <br />Roger Nawrot, Assistant City Engineer <br />Derick Roberts, Director of Streets & Sewers <br />- - - ------------- EJ Ed Gleckler, Manager Bureau of Traffic & Lighting <br />