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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/20/2017 Department Fire <br />BPW Date 5/9/2017 Phone 9255 <br />Name Stephen Cox, Fire Chief <br />o Legal ❑ Attorney Name <br />a 11-1 <br />o i- Controller review is required for all Contracts $5,000.00 or more <br />o o Controller Eland greater than one year in length per the City Purchasing <br />a m Policy <br />U) Purchasing ❑ <br />Check the Appropriate Item Type -- Required for A# Submissions <br />❑ <br />A j reement <br />❑ Contract <br />❑ Proposal <br />[:]Addendum <br />❑ <br />Claim <br />❑ <br />Bid Opening <br />❑Bid <br />Award ❑ Req. to Advertise <br />I ❑ Title Sheet <br />❑ <br />Quote Opening <br />Quote Award <br />❑ <br />Chg Order No. <br />❑ <br />CIO & PCA No. <br />❑ <br />CA <br />❑ <br />Ease./Encroach. <br />❑ <br />Traffic Control <br />Resolution <br />® Other: Disposal -Unfit <br />ro Pert ._ ._...�.... <br />Company or Vendor Name <br />New Vendor <br />❑,Yes ❑ <br />No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Helmet and boots for retirees: Gene Amor and Tom Kowalski <br />Amount of <br />❑ <br />❑ <br />Increase <br />Decrease <br />I $ <br />1 $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />