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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/7/19 <br />Name <br />d .�Department Enineerin ......... <br />BPW Date 5/14/19 Phone Extension 9083 <br />FffiI NNEW6W4F fl�/�NnNiiiM� lNXiiMhfM0101011111111111111111111111111111111111111111MIMIMIIIIIIIIMIMIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIImImIIMIYAW@Ww i •�+ BNYuSfM�Y'NIHN +i'���IPY' Yp.NWM19.NNVPFN�W.iGi! E <br />.... ...�� <br />d Prior to Submittal to-..........�.....�a�� <br />Require„ Board <br />Legal ❑ <br />Attorney Name Clara McDaniels <br />Controller ❑ <br />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 />Michael Schmidt <br />Type— Required Submissions <br />Check the A�]Con <br />�..AddendumW <br />❑ Agreement <br />rItem <br />Proposa <br />❑ Professional Services <br />El Resolution <br />n Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Opening <br />❑ Quote Award <br />Change Order No. 1 <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />F1 Traffic Control <br />❑ Other: <br />_.._........__ <br />_.... Required Information ... _... �....._........................ <br />Company or Vendor Name <br />Milestone Fence LLC. <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />JMS Buildina: Parkina Lot Improvements <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />118-003 <br />River West TIF <br />324-_1050-460-42.02 <br />Base plus alternates <br />Installation of additional concrete sidewalk <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, etc. <br />Required For Ch nqe Orders Only, <br />Dispersal After Approval <br />Copy Original <br />® ❑ Kyle Silveus <br />as ...................... <br />