Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />12/4/2017 <br />Sue Ellen Doudrick <br />Department <br />1WA4&-i0J1r?,i0rW <br />Public Works <br />Engineering <br />BPW Date 12/12/2017 Phone Extension 5922 <br />Legal ❑ Attorney Name: Clara McDaniels <br />Controller El 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 n <br />H Agreement Amendment <br />Professional Services <br />❑ Bid Opening, <br />F-1 Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other- - <br />Company or Vendor Name <br />H Contract <br />F-1 Resolution <br />F-1 Bid Award <br />El Quote Award <br />El C/O & PCA No <br />R Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/BE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Proposal Ll Addendum <br />0 Req. to Advertise [:1 Title Sheet <br />sm <br />Lexon Insurance Company tut" ) <br />El Yes [:1 No El If Yes, Approved by <br />Purchasing <br />U MBE LJ WBE <br />F1 No El Yes Name of Company <br />Lafayette Falls Phase IV, Section I <br />$29,775.00 <br />Approval of bond for Lafayette Falls Development Phase IV, <br />Section I <br />n Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non, -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of ❑ increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />F-1 <br />El <br />F-1 <br />F1 <br />El <br />El <br />