Laserfiche WebLink
Date 10-31-16 <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Department Public Works <br />Name <br />Kevin Fink <br />Division/Bureau <br />Engineering <br />BPW Date <br />11-08-16 <br />Phone Extension <br />5903 <br />I Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <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 />❑ <br />Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ® Req. to Advertise ® Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control: <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <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 />Increase <br />Decrease <br />Information <br />❑ Yes ❑ No ❑ if Yes, Approved by <br />Purchasin <br />MBE WBE <br />❑ No ❑ Yes Name of Company <br />Fire Station #4 <br />116-066 <br />West TIF area <br />050-460.36-01 <br />Request to Advertise, Notice to Bidders, and Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Chanqe Orders <br />ieVROVED <br />Previous Amount $ n <br />Current Percent of Change: % 4 r New Amount $ ! `•� L: <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Steve Cox <br />® ❑ Todd Skwarcan <br />® ❑ Kevin Fink <br />