Laserfiche WebLink
Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE, QUEST FORM <br />12/06/2,017 <br />6�m Shirk, Senior Budget Analyst Department <br />Admin & Finance <br />BPW Date 12/21/2017 Phone Extension 9133 <br />Required Prior to Submittal to Board <br />Legal El Attorney Name <br />Controller ❑ Controller review is, required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />H Agreement 1H Contract 01 1 ILI Proposal 1-1 Addendum <br />R Professional Services ', esolution ao� <br />F-1 Bid Opening 413id Award El Req. to Advertise El Title Sheet <br />❑ Quote Opening R Quote Award <br />Change Order No. R C/O & IPCA No. ❑ PCA <br />❑ Ease/Encroach. Traffic Control <br />❑ Other: Disoosalls <br />Company or Vendor Name <br />New Vendor <br />0 Yes El No 0 If Yes, Approved by Purchasing <br />MBEANBE Contractor <br />F MBE F WBE <br />MBE/WBE Contractor Requested F No F-1 Yes Name of Company <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F-1 increase $ <br />[:] Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy Original <br />E] El <br />F-1 F-1 <br />El F <br />