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SpUT!! 8 <br />OFFICE OF THE CONTROLLER AND <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM „65 <br />Date May 19, 2008 Department Engineering <br />BPW Date May 26, 2008 Phone 5937 <br />Name Carl Littrell <br />o <br />Legal <br />® <br />Attorney Name: Cheryl Greene <br />V o <br />Controller <br />❑ <br />Controller review is required for all Contracts $5,000.00 or more and greater than one <br />� O o <br />year in length per the City Purchasing Policy <br />a� P-4 pa <br />Other <br />Appropriate <br />❑ <br />Other, as appropriate: <br />V.) <br />Reviewers <br />rA <br />a� <br />'o <br />o� <br />Type of Item ❑ Contract/Agreement ❑ Proposal ❑ Addendum ❑ Claim <br />® Easement/Encroachment ❑ Resolution ❑ Traffic Control Device <br />❑ Other: ----------------- ----------------------------------------- <br />-------------------------------- - <br />Company or Vendor Name MIM A. Zielinski and Ms. Bonnie Bejma Hosinski <br />Project Name Fairfax Estates Area Draina e Im rovements <br />Project Number (Engineering) 108-014 <br />Amount <br />Purpose/Description <br />Terms of Contract: <br />Type of Item <br />$3500 Funding Source bond issue <br />Accept easement for sewer in rear yards of two property owners adjacent to <br />the improvement area. <br />------------------------------------------------------------------------------------------ <br />Compensation for Zielinski is $3500 cash. Compensation Bejma is <br />installation of sewer lateral to serve remainder of that property: ............ <br />❑ Advertise ❑ Bid Opening❑ Bid Award ❑ Quote Opening ❑ Quote Award <br />❑ Title Sheet ❑_Other <br />Company Name <br />Project Name <br />Project Number (Engineering) <br />Contract/Project Amount <br />Funding Source <br />i Type of Item ❑ Chg Order El C/O & PCA PCA Other: <br />--------------------------------------- <br />-------------- <br />E 2 Contractor/Consultant Name <br />i1 Project Name <br />O Project Number (Engineering) PO Number <br />obb Amount of ❑Increase ❑Decrease $ Funding Source <br />I Original Contract/Project Amount $ Current Percent of Change: <br />1 U New Contract/Project Amount $ Total Percent of Change: <br />E Purpose/Description: <br />List Name, Dept., Address (if appropriate) of who should receive document <br />^� Copy Original <br />❑ ❑ <br />�Q ❑ ❑ <br />