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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 20, 2019 <br />........... �..._..w_..ww ...... <br />Name Kyle Silveus Department Entneerin <br />BPW Date August 27, 2019 Phone Extension 9083 <br />ism mew i in awir HPIMmmmmmmmmmimi mm mm <br />Required, Prior to Submittal to Board <br />Legal E] Attorney Name <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 1:1 <br />__._. Check th <br />F-1 Agreement <br />F� Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />F-1' Change Order No. <br />Ease/Encroach. <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />" Contract <br />[l Resolution <br />El Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />)r All Submissions <br />Proposal Addendum <br />® Req. to Advertise ® Title Sheet <br />❑ PCA <br />Yes ❑ No ❑ If Yes, Approved by Purchasing <br />[:] MBE ❑ WBE <br />mMain St. & Wayne St Garage ImprovementsRWDA <br />119-066 <br />324-1050-460-42.02........v..�y.._.........................�.�.�...................... <br />............................�...._...........-... �. <br />BD <br />_ <br />a�..........m.._�w_............ .......���................_ <br />p Alternates Base Bid lus Alternm to... �_�__........................ <br />Repairs to the Existing Parking Garage <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion„ Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ �.. <br />❑ Decrease $... <br />Previous Amount $. <br />Current Percent of Change;_ %' <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval w. <br />Copy Original <br />