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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/02/2019 Department Engineering <br />Name Toy Villa Division/Bureau DPW <br />f� ............... <br />BPW Date 01/22/2019 Phone Extension 5920 <br />NM0NN9MffffWM19fflMMMMMMMMMM <br />— — — ------------- — - Required Prior to Submittal to Board <br />Legal F-1 Attorney Name: <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 El <br />Check the AppIq _' riate Item Type, —.Required for All Submissions <br />Agreement El Contract El Pro p—os"a u m <br />El Professional Services 0 Resolution <br />F-1 Bid Opening El Bid Award Req. to Advertise El Title Sheet <br />E] Quote Opening El Quote Award <br />El Change Order No. C/O & PCA No. PCA <br />0 Ease/Encroach. Traffic Control: <br />H Other: <br />Required Information <br />.......... ­­­ ------- - <br />Company or Vendor Name <br />Pemberton Davis Electric <br />New Vendor <br />........ A �oyqq by <br />Yes- . . . . ....... . ... . .. .... . . . .... <br />�Z_N� F-1 If Ye <br />MBEIWBE Contractor <br />. <br />MBE 0 WBE ­­_­ _§i _Tp <br />MBE/WBE Contractor Requested <br />11-0, 4 b—ompan . ..... <br />College Avenue & Sunnymede Avenue Traffic Calming - Solar <br />Project Name <br />Radar Speed Dis Ip ay Suns <br />Project Number <br />117-113A <br />Funding Source <br />LRSA <br />Account No. <br />. . . . ........... — ­­ -- -------_­, <br />— - <br />251.0608.431.42.96 <br />Amount <br />..t25,420.00 . ....... . .... <br />Terms of Contract <br />Purpose/Description <br />Project Closeout . . ........ <br />[:] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />squired For Chancie Orders Onlv <br />Amount of increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Chanae: <br />Dispersal After A <br />Copy <br />Original <br />F� <br />El <br />F� <br />El <br />❑ <br />El <br />