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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/13/16 <br />Bussell. Matthew <br />Department Utilities/Water Works <br />BPW Date 12/22/16 Phone Extension 5670 <br />Legal ❑ Attorney Name Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />❑ Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. ® PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />❑ Other: <br />RequiredInformation <br />Company or Vendor Name <br />Zimmerman Industrial <br />Piping <br />New Vendor <br />❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />North Station Filtration Plant Vessel #5 Raw Water SS pipe <br />Project Name <br />replacement <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Previous Amount <br />Water Works Operating Fund <br />620.0640.602.36.05(Labor) 620.0640.604.23.10(Materials) <br />$ Labor $9,208.00, Materials $22,677.50, Total $31,885.50 <br />Replacement of Stainless Steel Piping that is leaking. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination. Non -Debarment. E-Verifv. Iran. etc. <br />Increase <br />Decrease <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ Matthew Bussell <br />® <br />❑ Kim Thompson <br />❑ <br />❑ <br />