Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5 Aug 2016 <br />Name Cecil Eastman Department Admin/Fin <br />BPW Date 23 Aug 2016 Phone Extension 9317 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution 3q--10 /v <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />IRI Other: Asset Dis Dosal <br />Company or Vendor Name <br />New Vendor ❑ Yes ❑ No [ <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes <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 />Previous Amount <br />It Yes, Approved by Purchasing <br />Name of Company <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc <br />Increase <br />Decrease <br />uired For Change Orders <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />❑ ® Cecil Eastman <br />® ❑ Mary Wisniewski <br />❑ ❑ <br />