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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 12, 2018 <br />Name _§en Department <br />jqq�in Dougherty Admin & Finance <br />. ................... <br />.... .......... . . . ........................ <br />.... . . . . . ........... . .................... <br />BPW Date December 20, 2018 Phone Extension 7678 <br />.......... . .................................. <br />L .. ............. .............. ...... Required Prior to Submittal to Board <br />----- - — <br />Legal x Elliot Anderson — ----------------- --- Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing [:] <br />Check the A <br />F-1 Agreement <br />F-1 Professional Services <br />Fj Bid Opening <br />R Quote Opening <br />El Chg Order No. <br />F-1 Ease./Encroach. <br />� Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />iropriate Item for AlSubmissions <br />. ....... . ..... . — Required <br />[:] Contract [ Proposal <br />El Amendment <br />F-1 Bid Award El Req. to Advertise <br />El Quote Award <br />E] C/O & PCA No. EJ PCA <br />Traffic Control F] Resolution <br />[j Claim <br />Required Information <br />Addendum <br />0 Title Sheet <br />Cavanaugh Macdonald Consult_ipg,, LLC <br />F1 Yes F-1 If Yes, Approved by Purchasing <br />No <br />WBE <br />MBE Completed E-Verify Form Attached ❑Nos <br />Pension Relief Actuarial Valuations as of 12/31/2018 <br />......... ..................................... ................... <br />None <br />701-0903-645.31-06; 702-0803-645.31-06 <br />t-6—,"4­0 0ib"O-------------- . . . . . . ........................ <br />Purpose/Description Contract for professional services of actuarial consultant selected <br />by INPRS for annual police and fire pension relief valuations <br />under GASB 68. <br />For Change Orders 0 <br />. ..... n_y__ <br />Amount of increase $ ............ <br />F ] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />