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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 29, 2019 <br />Name K le Silveus Department . Engineering <br />_...... y�....... _ ...................................... ._ <br />BPW Date Aril 9, 2019 Phone Extension 9083 <br />IVI'ANG! � NVIVNIMNNm .. � NNPMM <br />.-. ....... ........... ...... <br />_.—Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the <br />❑ Agreement <br />0 Professional Services <br />❑ Bid Opening <br />Quote Opening <br />F-1 Change Order No. _ <br />Ease/Encroach. <br />Other: Bid llctio <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 />Purpose/Description <br />Amount of <br />F] <br />ropriate Item Type <br />C3 Contract <br />❑ Resolution <br />Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />_ <br />7 Traffic Control <br />for All Submissions <br />D Proposal ❑ Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />ired Information <br />❑ PCA <br />TBD <br />Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE ❑ WBE <br />Main St./Wayne St. Garage Improvements <br />118-096R <br />.�.�.�.�.�.�.�.��_� _� ��.._.�..................._._ w.�. <br />RWDA <br />...................... ................................................m. 3.�24_....................... _ ����_�_...�..........mm.. <br />-1050-460-42.02 <br />N/A _ <br />Roof and other Misc. Repairs to the Existing Parking Garage Tower <br />s, <br />Canopy, and Facade <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non-Discrim i nation, Non -Debarment, E-Verh, Iran, etc. _ <br />Required For Chan e�0_rders Only <br />. <br />Increase $ <br />Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Appr <br />oval <br />Copy <br />Original <br />El <br />E <br />❑ <br />F <br />