Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/13/2017 <br />Department Public Works <br />Name Richard Estes <br />Division/Bureau Engineering <br />BPW Date 01/24/2017 <br />Phone Extension 5896 <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: Michael Schmidt <br />Controller ❑ <br />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 />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 />Sherwin Williams <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 />Project Name <br />Equipment Purchase for Nei lo Corporation Phase XIV <br />Project Number <br />116-135 <br />Funding Source <br />River West Development TIF <br />Account No. <br />324.1050.460.42.07 <br />Amount <br />$104,879.00 <br />Terms of Contract <br />Purpose/Description <br />Trailer Mounted Vapor Media Blaster <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />® ❑ Aaron Kobb <br />® ❑ Robert Rumpler (Nello Corp) <br />❑ ❑ <br />