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Date <br />BPW Date <br />Name <br />OFFICE OF THE CONTROLLER AND <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />July 5, 2007 Department C&ED <br />July 19, 2007 Phone <br />Bill Schalliol <br />235-5842 <br />`o _ Legal ® Attorney Name: <br />p� Controller review is required for all Contracts $5,000.00 or more and greater than one <br />Controller ❑ year in length per the City Purchasing Policy <br />a > (/) = OTHER <br />a.) o o APPROPRIATE ❑ Other, as appropriate <br />REVIEWERS <br />Type of Item ❑Contract/Agreement ❑Proposal ❑Addendum ❑Claim <br />®Easement/Encroachment ❑Resolution ❑Traffic Control Device <br />CC ❑ Other: <br />--------------------------------------------------------------------------------------------- <br />a? Company or Vendor Name Easement agreement with Niles/Washington LP (Holladay Prop.) <br />N Project Name East Washington Street Improvements <br />w o Project Number (Engineering) Proj. Code (Controller) <br />o Amount $ Funding Source <br />U v Purpose/Description: Easement related to public improvements constructed in the N/S alley north <br />of East Washington Street related to East Washington Street project. <br />--------------------------------------------------------- ----------------------------- <br />o -a Terms of Contract: Easement runs with the land and has no time reslriction. <br />V <br />---------------------------------------------------------------------------------•- <br />Effective Date Upon End Date N/A <br />approval <br />Type of Item ❑Advertise ❑Bid Opening ❑Bid Award ❑Amendment ❑Title Sheet <br />❑Other <br />Y------------------- -------------•-----------•-__•_•---------------••------------------------------' ' <br />Company Name <br />o Project Name <br />0.i Project Number (Engineering) Proj. Code (Controller) <br />Contract/Project Amount $ Funding Source <br />Type of Item ❑Chg PC Order ❑C/O & PCA ❑A ❑Other: <br />------------ - --- - -------------------------------------------------------- <br />Contractor/Consultant Name <br />Project Name <br />Project Number (Engineering) Proj. Code (Controller) <br />PO Number Funding Source <br />Amount of ❑Increase ❑Decrease $ Total Percent of Change: <br />Original Contract/Project Amount $ <br />New Contract/Project Amount $ <br />Purpose/Description: <br />List Name, Dept., Address (if appropriate) of who should receive document <br />Copy <br />Original <br />> <br />❑ <br />❑ <br />❑ <br />❑ <br />. cn C-- C. <br />Q � Q <br />❑ <br />❑ <br />