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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/2/16 <br />Name John Martinez Department Parks <br />BPW Date 812/16 Phone Extension 235-7645 <br />Required Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement <br />❑ Contract <br />❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Bid Opening <br />® Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />I-1 Claim <br />Company or Vendor Name <br />New Vendor <br />MBEM/BE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />RecSource <br />❑ Yes <br />® No <br />❑ MBE <br />❑ WBE <br />Fremont Par <br />PB18 <br />Park Bond <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />If Yes, Approved by <br />k <br />Completed E-Verify Form Attached ❑ Yes <br />❑ No <br />Splash Pad <br />In ana construction of SK <br />For Change Orders Only <br />Dispersal After Approval <br />