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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/21/2018 <br />Department VPA.- Facilities & <br />Name Patrick Sherman Grounds <br />BPW Date 11/27/2018 Phone Extension 5601 <br />R uired Prior to Submittal to Board <br />- - ----------- tip.. _­" — — --------------- — — ------- — -- . ..... <br />Legal 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 Michael Schmidt <br />Check the p op riate Item.,Type - Requited for All Submissions <br />1"Contract ..... ... .... :_IP ---- ropo sal Addendum <br />M_ ement E <br />El Professional Services EJ Resolution <br />El Bid Opening E] Bid Award El Req. to Advertise El Title Sheet <br />El Quote Opening El Quote Award <br />E] Change Order No. El C/O & PCA No, El PCA <br />0 Ease/Encroach. E] Traffic Control <br />Uer Other: <br />. . . . . .. ...... <br />Company or Vendor Name <br />All Phase Electrical Su <br />New Vendor <br />............ <br />E] Yes E No ❑ If Yes, Approved by Purchasing <br />MBENVBE Contractor <br />F-1 MBE F-1 WBE <br />MBEANBE Contractor Requested H No [:] Yes Name of Company <br />Project Name <br />Century Center Li-qht Fixtures <br />Project Number <br />1066-2018 <br />Funding Source <br />Hotel/motel Tax <br />Account No. <br />N/A <br />Amount <br />57,675.00 <br />Terms of Contract <br />. . .......... ... . . ..... . . . ......... . . <br />Lump Sum per Goods and Services Agreement <br />Purpose/Description <br />Ligbh!!99_Fixtures to expand LED liahtinq at Century Center <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discri m i nation, Non -Debarment, E-Verify, Iran, etc. <br />. .......... __ . . . ............ .. . ............ <br />'Required For Change Orders Only <br />Amount of F] increase $ <br />EJ Decrease $ <br />Previous Amount <br />Current Percent of Change, <br />New Amount <br />Total Percent of Change: <br />DispersalAfterApproval <br />Copy <br />Original <br />F] <br />1:1 <br />F] <br />El <br />El <br />1:1 <br />