Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/11/2018 Department <br />Name Toy Villa Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 01/23/2018 Phone Extension 5920 <br />Required Prior to Submittal to 'Board <br />Legal F-1 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 />[❑I Agreement Amendment <br />F] Professional Services <br />F-1 Bid Opening <br />[I Quote Opening <br />F-1 Change Order No. <br />n Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name, <br />H Contract L] Proposal LJ Addendum <br />F1 Resolution <br />El Bid Award El Req. to Advertise El Title Sheet <br />El Quote Award <br />❑C/O & PCA No. Z PCA <br />❑ Traffic Control: <br />New Vendor <br />MBENVBE Contractor <br />MBE/1/BE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of L_J <br />El <br />Ziolkowski Construction, Inc. <br />El Yes Z No ❑ if Yes, Approved by <br />Purchasing <br />[:] MBE [:] WBE <br />n No El Yes Name of Company <br />Century Center Masonry Restoration <br />117-037 <br />Hotel -Motel' <br />7304.42010.000.0099 <br />31EWi 1 1 "• <br />Proiect Closeout <br />F-1 Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment. E-Verifv, Iran. etc. <br />I ncrease $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />F] Leanna Belew <br />El <br />El <br />