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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/16/2016 Department <br />Richard Estes <br />Public Works <br />Division/Bureau Engineering <br />BPW Date 12/22/2016 Phone Extension 5896 <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 ® George King <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 />I-1 <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE 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 />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Equipment Purchase for Nello Corporation Phase XVII <br />116-144 <br />River West Development TIF <br />324.1050.460.42.07 <br />Advertisement for the purchase of computer equipment for Nello <br />Corporation. First Ad 12/30, Second Ad 01/06, Open Bids 01/24 <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ Pkg��r <br />Current Percent of Change: % Hoard of Public Warkg <br />New Amount $ <br />Total Percent of Chanqe: % <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />RM 7671106 <br />