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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/30/2019 Department Public Works <br />Name Roger Nawrot Division/Bureau Engineering <br />BPW Date 0 �....�_......._____........_ <br />5/14/2019 Phone Extension 5932 <br />�.. x� m�mrn mmmmmmmuim�mi� rww�o� mmmm�mmmim��muuuuuuuuuummuwimmmmmwwm <br />..............._ i�uired Prior to Submittal to Board <br />Legal E] 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 E <br />Check the <br />Jj Agreement <br />El Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />® Change Order No. 2 <br />❑ Ease/Encroach. <br />F Other: <br />Company or Vendor Name <br />pro pate Item <br />Type -. <br />El Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No,. <br />El Traffic Control: <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 />for All Submissions <br />1 Proposal <br />n Req. to Advertise <br />uired Information <br />HRP Construction, Inc. <br />E]PCA <br />Approval of C.O. #2 — Time Extension of 6 days <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E Verify+, Irar,t etc. <br />-,uired For Chaniale Orders Onlv <br />Amount of Increase $ <br />E Decrease $ <br />Previous Amount $ <br />Current Percent of Change.. % <br />New Amount $ <br />Total Percent of Chanoie %� <br />Disoersal After Aooroval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />