Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/10/17 <br />Name Leanna Belew Department Century Center <br />BPW Date 01/17/17 Phone Extension 9184 <br />Legal ❑ Attorney Name <br />Controller X❑ 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 X ❑ <br />Chock tha Annrnnrinfa Ham Tuna _ Rn^,,; rr fnr du CiiAm:on:nnn <br />❑ Agreement <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. _ <br />❑ Ease/Encroach. <br />Other: Request for <br />Contract <br />Resolution <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />Traffic Control <br />Company or Vendor Name <br />New Vendor ❑ Yes <br />❑ Req. to Advertise <br />❑ PCA <br />It Yes, Approved by Purchasing <br />MBEJWBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Form Attached (Non - <br />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 />❑ <br />Dispersal After Approval <br />