Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date '12-18-17 <br />Name Santiago Garces Department Innovation <br />BP Date 12-21-17 Phone Extension 7652 <br />F_ Required Prior to Submittal to Board <br />Legal Attorney Name Dougherty <br />Controller Controller review is irequired for all Contracts $5,000,00 or more and <br />greater than one year in length per the City Purchasing Policy <br />LJ Agreement <br />H Contract LJ Proposal Ll Addendum <br />Professional Services <br />F] Resolution <br />Bid Opening <br />EJ Bid Award El Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />El Quote Award <br />F-1 Change Order No. <br />F-1 C/O & PCA No. El PCA <br />El Ease/Encroach. <br />❑ Traffic Control <br />n Other: <br />Required information <br />Company or Vendor Name Jacob Burnett <br />New Vendor El Yes M No El If Yes, Approved by Purchasing <br />MBEANBE Contractor F1 MBE F] WBE <br />MBENVBE Contractor Requested 0No F-1 Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source IT Fund Professional Services <br />Account No. 404-0672-415-31-06 <br />Amount $35,000 <br />Terms of Contract 1/11/2018 — 6/30/2018 <br />Purpose/Description Professional Services for Redevelopment Supervisory Services <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Amount of F-1 <br />El <br />Increase $ <br />Decrease $ <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 />Santiago Garces <br />Shawn Delahant, <br />❑ Dan O'Connor <br />