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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 4, 2019 <br />Name Becca Plantz <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date February 12, 2019 Phone Extension 5998 <br />mmmmmunn mm ommmmimmmmummimmmmmmmmmmimm i i i i i imlwlum i i i immm M mmmm <br />Required Prior to Submittal to Board <br />_ <br />Legal ❑ Attorney Name: Clara McDaniels ..Wv- <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 ❑ <br />Check the <br />0 Agreement Amendment <br />El Professional Services <br />E] Bid Opening <br />Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />F-1 Other: <br />Tpprnate ItemITT r q_— <br />❑ Contract <br />F] Resolution <br />�] Bid Award <br />Quote Award <br />F] C/O & PCA No. — <br />n 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 />uired Inform <br />Brown & Brown <br />for All Submissions <br />I Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Bendix Lift at CenturCenter ................. ._........................ <br />118-036C <br />Hotel Motel Tax Fund <br />7304.42010.000.0099 <br />$71,300.00 <br />Lump Sum .�...... <br />........... ... <br />Install ADA lift in Bendix Theater at the Centu Center, <br />Required Contractor's Certification Forms Attac <br />hed ched (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.. RegL <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: A�.m.. <br />New Amount $ <br />Total Percent of Chanee: <br />Dispersal After <br />Copy Original <br />® ❑ Becca Plantz <br />.- <br />❑.............................................. <br />0 ............_....-.._....... <br />_................................... <br />