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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 3, 2017 <br />Ed Herman <br />Department Water <br />BPW Date March 14, 2017 Phone Extension 6108 <br />Required Prior to Submittal to Board <br />Legal x 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 />ChecK the Appropriate Item I ype — Kequlred for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening x Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Required Information <br />Company or Vendor Name M E Simpson Company <br />New Vendor Ll Yes x No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Large Meter Testing <br />Project Number <br />Funding Source Water Works Operating Fund <br />Account No. 620-0640-605-31-06 <br />Amount $ 57,275 <br />Terms of Contract One year with mutual option for a one year extension <br />Purpose/Description Testing of 2" and larger meters at customer locations <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />❑ x <br />x ❑ <br />x ❑ <br />For Change Orders O <br />% <br />Dispersal After Approval <br />Roxanne Lawson <br />Kim Thomp <br />Ed Herman <br />