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ra <br />LM <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 8, 2011 Department C &ED <br />BPW Date June 23, 2011 Phone 235 -5842 <br />Name Bill Schalliol <br />o Legal ® Attorney Name L. Meteiver <br />2 -ia -v Controller review is required for all Contracts $5,000.00 or more <br />o_` o Controller ® and greater than one year in length per the City Purchasing <br />Of <br />n`. m Policy <br />Other Appropriate Reviewers ❑ <br />Chprk the Annrnnrintiz itfCM Tv.,m - D.im— ,,,c. -.,i' t. .n a C%.....L-,.:._ �_ -- - <br />A reem int <br />❑ Claim <br />I El Contract Proposal Addendum <br />Bid Opening <br />❑ <br />Bid Award <br />assign .- t 1 !- o Y <br />Req. to Advertise <br />SSDA TIF <br />Title Sheet <br />I F1 Quote Ogening <br />R <br />Quote Award <br />❑ <br />Chg Order No. <br />LJ <br />C/O & PCA No. <br />Total Percent of Change: <br />PCA <br />% <br />Ease. /Encroach, <br />Traffic Control <br />LJ <br />Resolution <br />❑ <br />Other: <br />Company or Vendor Name <br />❑ <br />❑ <br />New Vendor <br />Project Name <br />❑ Yes No ❑ If Yes, Approved by Purchasing <br />748 Hawbaker Demolition Planning Project <br />Project Number <br />assign .- t 1 !- o Y <br />Funding Source <br />SSDA TIF <br />Account No. <br />430 - 1050 -460 -31.06 <br />Amount <br />is <br />Terms of Contract <br />Purpose /Description <br />i <br />Addendum related to 748 Hawbaker Demolition Planning Proiect <br />Total Percent of Change: <br />lAmount of <br />_ <br />❑ <br />❑ <br />I Increase <br />Decrease <br />$ <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />=9 <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Copy <br />Original <br />® <br />❑ <br />aspeM After Approval <br />Cheryl Phipps, CED <br />Bill Schalliol. CED <br />