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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/02/20118 <br />Name Patrick Sherman <br />Department VPA: Facilities & <br />Grounds <br />BPS` Date 01/09/2018 Phone Extension 5601 <br />Required Prior to Sulbmittal to Board <br />LegalAttorney Name Dani Campbell <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 Michael Schmidt <br />Ll Agreement <br />U Contract U Proposal L1 Addendum <br />OProfessional <br />Services <br />F-1 Resolution <br />0 <br />Bid Opening <br />El Bid Award M Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. PCA <br />❑ Ease/Eincroach. <br />❑ Traffic Control <br />F1 <br />Other: <br />Company or Vendor Name TBD <br />New Vendor El Yes El No, F] If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE n WBE <br />MBEANBE Contractor Requested F1 No ❑ Yes Name of Company <br />Project Name Plumbing Services Contract <br />Project Number 1040-2018 <br />Funding Source K61 RMT <br />Account No. 201-1101-452 36.01 <br />Amount $ TBD <br />Terms of Contract Contract details to be negotiated after RFP selection process <br />Purpose/Description Plumbing services contract for VPA <br />0 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.' <br />Amount of F-1 increase <br />E] Decrease <br />Previous Amount $ <br />Current Percent of Change. <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />❑ <br />F] <br />El <br />El <br />0/n <br />0 <br />