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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/04/18 <br />Name Lory Timmer <br />Department DCI <br />BPW Date 1/23/18 <br />Phone Extension 5841 <br />b Jt6d'P.r1brtoum' ,S; <br />Legal Z <br />Attorney Name Clara McDaniels <br />Controller <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 z <br />❑ <br />Agreement <br />F1 Contract ❑ Proposal ❑ Addendum <br />F-1 <br />Professional Services <br />F-1 Resolution <br />F-1 <br />Bid Opening <br />F-1 Bid Award F] Req. to Advertise ❑ Title Sheet <br />n <br />Quote Opening <br />F-1 Quote Award <br />F-1 <br />Change Order No. <br />❑ C/O, & PCA No. ❑ PCA <br />El <br />Ease/Encroach. <br />❑ Traffic Control <br />M <br />Other: Amendment <br />Company or Vendor Name Department of Community Investment <br />New Vendor F Yes Z No n If Yes, Approved by Purchasing <br />MBE/WBE Contractor F-1 MBE F1 WBE <br />('o/IBE/WBE Contractor Requested Z NoF1 Yes Name ofCompany <br />_ <br />Project Name Emergency Solutions Grant ESG) Program Administration <br />Project Number 17-J'E-01 <br />Funding Source Emergency Solutions Grant (ESG) <br />Account No. 212.1001.460.39.30 <br />Amount $20,375 (increase from $3,308 to $20,375) <br />Terms of Contract 1/0 1 /17 — 12/31 /17 <br />Purpose/Description <br />Amount of n <br />F1 <br />Increase contract amount bV $17,337 so that expended ESG costs <br />from previous years may be drawn <br />M Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Non -Debarment. E-Verifv. Iran, etc. <br />increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy <br />Original <br />M <br />F-1; Judy Love <br />El <br />El <br />El <br />