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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />10/15/19 <br />Kvle Silveus <br />Department En ineerin <br />BPW Date 10/22/19 Phone Extension 9083 <br />Re hired Prior to Submittal to Board - <br />Legal ❑ Attorney Name Clara McDaniels <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 />Che, <br />" Agreement <br />El Professional Services <br />Bid Opening <br />❑ Quote Opening <br />F-1 Change Order No. <br />El Ease/Encroach. <br />F� Other: <br />❑ Michael Schmidt <br />L....l Contract <br />❑]I Resolution <br />❑ Bid Award <br />❑' Quote Award <br />�C/O &PCANo, <br />Traffic Control <br />4 for All Submissions <br />El Proposal El Addendum <br />® Req. to Advertise „Title Sheet <br />❑ PCA <br />Company or Vendor Name N/A <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE FIWBE <br />MBE/WBE Contractor Requested ❑ No n Yes Name of Company <br />Project Name mmTwo-Way Conversion of Colfax Ave. — Phase II <br />Project Number 115-053B <br />Funding Source West Washington Development Area TIF <br />Account No. 422-1050-460-42-03 <br />Amount $ N/A <br />Terms of Contract <br />Purpose/Description ❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />, <br />Amount of ❑ Increase <br />Decrease $ <br />Previous Amount $ <br />VIE a <br />Current Percent of Change: % P <br />New Amount ... W. <br />Total Percent of Chan <br />Copy <br />Original <br />R <br />❑ <br />El <br />❑ <br />