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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Public Works <br />Division/Bureau Engineering <br />BPW Date 01/24/2017 Phone Extension 5896 <br />F- Required Prior to Submittal to Board <br />Legal ® Attorney Name: Michael Schmidt <br />Controller El greater <br />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 />01/13/2017 Department <br />Richard Estes <br />Purchasing ® <br />George King <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 />❑ <br />Other: <br />Required Information <br />Company or Vendor Name <br />BSCO, Inc. <br />New Vendor <br />❑ Yes ❑ No ❑ If Yes Approved by Purchasing <br />MBEM/BE Contractor <br />❑ MBE ❑ WBE <br />MBEM/BE Contractor Requested ❑ No ❑ Yes Name of Companv <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Equipment Purchase for Nello Corporation Phase XIII <br />116-134 <br />River West Development TIF <br />324.1050.460.42.07 <br />$53,500.00 <br />Steel pole inside seam welding system <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />I Required For Change Orders Onlv I <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />® <br />❑ Aaron Kobb <br />® <br />❑ Robert Rumpler (Nello Corp) <br />❑ <br />❑ <br />