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BOARD OF PUBIJC WORKS <br />AGENDA ITEM REVIEW IZE QUEST FORM <br />Date 12/14/2017 Department Fire <br />BPVV Date 12/21/2017 Phone 9255 <br />........... . . <br />Name Todd Skwarcan, A/C Services <br />..... .............. <br />0 Legal' Attorney Name Clara McDaniels <br />_0 -2 .1-1 <br />(V 0 — -2 Controller review is required for all Contracts $5,000.00 or more <br />, +- <br />m Controller Eland greater than one year in length per the City Purchasing <br />0 <br />on- CO Policy <br />Purchasing N Michael Schmidt <br />Check the ArmroDriate Item TvDe — Reauired forAll Submissions <br />❑ <br />Agreement <br />❑ Contract ProposaN Addendum <br />El <br />Claim <br />Ell <br />Bid Opening <br />El Bid Award I El Req. to Advertise El Title Sheet <br />El <br />Quote QpeDj!j <br />. . ..... <br />H Quote Award <br />Chg-Order No. <br />El <br />C/O & PCA No. <br />PCA <br />❑ <br />Ease./Encroach. <br />❑ <br />Traffic Control <br />❑ <br />Resolution <br />❑ <br />Other.- <br />Required Information <br />Company or Vendor Name Phoenix Safety Outfitters <br />New Vendor E]Yes M No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />MBE R WBE <br />Project. Name <br />Project Number <br />Funding Source <br />. . ....... ------ ---- - <br />Supplies/Other Operating Su lies <br />Account No. <br />287-0902-422-22.24 <br />Amount <br />$ 47,000 <br />Terms of Contract <br />Purpose/Description <br />Special purchase to replace obsolete helmets. <br />-------------­ <br />For Change Orders Only <br />� increase <br />Amount of 7D <br />$ <br />F� Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of - Chaai��- <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />Dispersal After Approval <br />Copy Original <br />El 0 <br />0 D <br />