Laserfiche WebLink
Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE' QUEST FORM <br />January 16, 2018 <br />Tara Weigand <br />Department <br />Division/Bureau <br />01-011=71iffin <br />Engineering <br />BPW Date January 23, 201'8 Phone Extension 5998 <br />Required Prior to Submittal to Board <br />Legal EJ Attorney Name-, <br />Controller El 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 1:1 <br />LJ <br />Agreement Amendment <br />Contract 0 Proposal 0 Addendum <br />F� <br />Professional Services <br />❑ <br />Resolution <br />F-1 Bid Opening <br />El <br />Bid Award Z Req. to Advertise M Title Sheet <br />F1 Quote Opening <br />F-1 <br />Quote Award <br />F-1 Change Order No. <br />R C/O & PCA No., ❑ PCA <br />Ease/Encroach, <br />F] Traffic Control: <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />El Yes [:] No F] If Yes, Approved by <br />Purchasina <br />L11 MBE LJ WBE <br />F-1 No F-1 Yes Name of ComDanv <br />Fire Station #9 <br />Advertise dates 2/2/18, 2/9/18 <br />F� Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of F1 increase $ Al'i"RovsD <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % JAN 2 3 01 j <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />M F] Steve Cox <br />H El Todd Skwarcan . .... . <br />F-1 EPOCH (Andrew Avara) <br />