Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1 <br />Name Toy Villa . <br />BPW Date lamPF& I <br />Department <br />Phone Extension <br />Engineering <br />5920 <br />I Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ <br />Agreement <br />❑ Contract ❑ Proposal ❑ Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ <br />Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Change Order No. <br />E(C/O & PCA No. PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control <br />❑ <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Indiana Earth, Inc. <br />❑ Yes ®No If Yes, Approved by Purchasing <br />❑ MBE F WBE <br />❑ No ❑ Yes Name of Company <br />Demolition of Vacant & Abandoned Houses — Phase IX <br />11 <br />EDIT <br />408.1201.415.39.89 <br />$ 168,650.00 <br />Project Closeout — Time Extension <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verif ,Iran, etc. <br />Required For Change Orders Only <br />Amount of ❑ Increase $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />® ❑ Elizabeth Maradik, Beth Leonard, Judy Love <br />® ❑ Kevin Fink <br />® ❑ Toy Villa <br />