Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12,/12/17 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 12/21/17 Phone Extension 5920 <br />Legal M <br />Attorney Name: <br />Controller El <br />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 E] <br />Check the Appropriate <br />Item Type - Required for All Submissions <br />0 Agreement <br />F-1 Contract ❑ Proposal ❑ addendum <br />F Professional Services <br />Resolution <br />F-1 Bid Opening <br />❑ Bid Award 0 Req. to Advertise Title Sheet <br />Quote Opening <br />F-1 Quote Award <br />Change Order No. <br />C/0 & PCA NoJ (Final) ❑ PCA <br />El Ease/Encroach. <br />❑ Traffic Control: <br />F Other: <br />Company or Vendor Name <br />New Vendor <br />MBEA/VBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />DBIL Services, Inc. <br />0 Yes 0 No El If Yes, Approved by Purchasing <br />MBE F1 WBE <br />No 0 Yes Name of Company <br />Specialty Pavement Markings <br />117-039 <br />LRSA <br />251.0608.431,42.93 <br />Project. Closeout <br />[:1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of El increase $ <br />E Decrease $ 1,525.85 <br />Previous Amount $22,146.11 <br />Current Percent of Change: 6.89�% <br />New Amount $20,620.26 <br />Total Percent of Change: 6.89% <br />Copy <br />Original <br />R <br />R <br />F-1 <br />R <br />El <br />El <br />