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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/3/2019 Department Public Works <br />Name Kyle Silveus................... . ..................m..... <br />_......................... _.,�....__. <br />Division/Bureau Engineering <br />BPW Date 9/10/2019 Phone Extension 9083 <br />__,_Required Prior to Submittal to Board <br />Legal E] Attorney Name: Clara McDaniels <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 />H Agreement <br />Professional Services <br />❑ Bid Opening <br />F-1 Quote Opening <br />Change Order No. 3 <br />Ease/Encroach. <br />[ Other: <br />Michael Schmidt <br />mpriate Item TYP — <br />Contract <br />I-1 Resolution <br />for All Submissions <br />I Proposal <br />Bid Award F-1 Req. to Advertise <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ 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 />Required Information <br />Environmental Glass <br />Addendum <br />❑ Title Sheet <br />Liberty Tower Exterior Renovations, Division C — Storefront and <br />Entrance <br />118-086 R <br />RWDA TIF <br />324-1050-460-42-02 <br />$3,813.31 <br />Terms of Contract <br />Purpose/Description Provide and install three power supplies and o � ic <br />p pp automatic <br />.._operators <br />............w.-..,.ElRequired Contractor's Certification Forms Attached ( Non <br />Collusion, <br />Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Re tamed For Chem a Orders Only, <br />.........�__ ._....__ �_.._ __ <br />Amount of ® Increase $ 3,813.3m1 <br />❑ Decrease $ <br />Previous Amount_....$....3.............................................ww ..........._.._.................................w...........ww..... �......... <br />01,992.46 <br />Current Percent of Change: 1.26% �..........__...,................................ �.�.�.�..m . <br />m.�. 805......... �_............ <br />�_�.._.................................................. �a__ <br />New Amount $ 305, .w.�7 � <br />Total Percent of Chanee: 0.59 /o <br />Dispersal After <br />Copy <br />Original <br />❑ <br />❑ <br />1-1 <br />El <br />F <br />El <br />