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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/4/18 Department Public Works <br />Name K _ ....._..... ______W....... ...... _ ..._ ...m ...�.... ��...... <br />yle Silveus Division/Bureau Engineering <br />._.� . .... — .._.�...._ ... ....�................—... — <br />BPW Date 12/11/2018 Phone Extension 9083 <br />'� ��� �/m1AMlAl�WIRA,YIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIWIliIM91WIW i 11W�@@W NR I�@Mi�IMINNN IIW <br />................. .- .. <br />.. _ —fM uired Prior to Submittal wto Board m —� <br />Legal Z Attorney Name: Clara McDaniels <br />Controller El 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 El <br />—mmIT�WWCheck the <br />H Agreement <br />® Professional Services <br />❑ Bid Opening <br />F-1 Quote Opening <br />Change Order No. _ <br />E' Ease/Encroach. <br />F-1 Other: <br />Michael Schmidt <br />pTp riate Itemw Type <br />❑ Contract <br />Resolution <br />d for All Submissions <br />Proposal <br />El Bid Award Req. to Advertise <br />El Quote Award <br />❑] C/O & PCA No. ❑ PCA <br />❑ Traffic Control:. <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 />Required Information <br />Lochmueller G <br />Yes..N <br />MBE <br />No F <br />No <br />IWWBE <br />Inc............... . .......... .. <br />If Yes„ Approved by Purchasi <br />Yes Name of Corn <br />Addendum <br />❑ Title Sheet <br />Phase 2 Design — Adds hourly Utility and RR coordination <br />services and additional geotechnical services and eliminates a <br />portion of unneeded APA services, <br />L' Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Eleuired For Change Orders Only. <br />Incm.......... <br />Amount of ❑ increase $ mmmmm — <br />Decrease $ <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />