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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/13/17 <br />Name JohnMurphy �i�l� Department Adm/Finance <br />BPW Date 3/28/16 Phone Extension 7678 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />Check the Appropriate Item Type — Required for All Submissions <br />® Agreement ® Contract ® Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Required Information <br />Company or Vendor Name Umbaugh <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />J Yes � No LJ If Yes, Approved by Purchasing <br />] MBE ❑ WBE <br />2017 Bond Continuing Disclosure Services <br />None <br />Administration <br />101-0401-415-31-06 <br />$ 15,000.00 NTE <br />Continuing disclosure services for January 1, 2017 through December 31, <br />2017 <br />Purpose/Description <br />❑ Required Contractor's Certification <br />Amount of ❑ Increase <br />n Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />For <br />Dispersal After <br />Jennifer Hockenhull <br />Form Attached(Non- <br />ient, E-Verifv. Iran, et( <br />