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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12/05/2017 <br />Kieran Fahey Department Engineering <br />N Agreement LJ Contract U Proposal LJ Addendum <br />® Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />R Other: <br />Company or Vendor Name: EmNet <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEIWBE Contractor ® MBE ❑ WBE <br />MBEIWBE 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 />Previous Amount <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval' <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />