Laserfiche WebLink
Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 7, 2017 <br />Tara Weigand <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date March 14, 2017 Phone Extension 5998 <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: Michael Schmidt <br />Controller El <br />review is required for all Contracts $5,000.00 or more and <br />greater <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® <br />George King <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />❑ <br />Agreement Amendment <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 />F1 <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBENVBE 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 />Amount of U Increase <br />❑ Decrease <br />M/E Design Services <br />o LJ If Yes, Approved by <br />Purchasin <br />❑ MBE ❑ WBE <br />❑ No 0 Yes Name of Company <br />Century Center Cooling Tower <br />117-035 <br />Hotel -Motel <br />7304.42010.000.0099 <br />7,100 <br />Replace existing cooling tower with a similar tower of the same <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />uired For Chanqe Orders <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Chanqe: % <br />® ❑ Kara M. Boyles <br />® ❑ M/E Design Services (Tom Cook) <br />® ❑ Scott Herczeg, Leanna Belew <br />