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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/30/2019 Department Public Works <br />Name Kyle Silveus Division/Bureau Engineering <br />BPW Date 10/8/2019 Phone Extension 9083 <br />�� m�ITITITmm _mRequiredmPrior to Submittal to Board._wwww � <br />Legal F-1 Attorney Name: Clara McDaniels <br />Controller El 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 ❑j Michael Schmidt <br />LJ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />® Change Order No. 4 <br />El Ease/Encroach. <br />F1 Other: <br />�I Contract <br />Resolution <br />Bid Award <br />El Quote Award <br />C/O & PCA No. <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 />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Terms of Contract <br />Purpose/Description Provide vestibule wall surrounding, 7 additional days_,, <br />...� Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />ouired For Chage_Orders Only <br />Amount of Increase $ 2,975.31 <br />Decrease $ <br />Previous Amount $ 305,805.77 <br />�.. .. .... �.... ........ <br />Current Percent of Change: ? ' <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />EI <br />El <br />F <br />$ 308,781.08 <br />1.57% <br />Disoer <br />I After Awroval <br />