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BOARD OF PUBLIC W0RI(,S <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/19/2018 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 03/27/2018 Phone Extension 5920 <br />------- <br />Required, Prior fo­Submittal to Board <br />Legal ❑ 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 />Lj Agreement H Contract H Proposal LJ Addendum <br />F1 Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening El Quote Award <br />❑ Change Order No. Z CIO& PCANo.1 (Final) FIPCA <br />❑ Ease/Encroach. ❑ Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBENVBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Acorn Landscaping LLC <br />❑ Yes, Z No If Yes, Approved by Purchasin <br />❑ MBE 0 WBE <br />E] No ❑' Yes Name of Company <br />2017 Downspout Disconnect Program <br />116-114 <br />WastAwateir 0 & M <br />641.0630.79163.35 <br />Proiect Closeout <br />E] Required Contractor's Certification Forms Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc. <br />Amount of ❑ increase $ <br />H Decrease $ 11,026.67 <br />Previous Amount $49,995.00 <br />Current Percent of Change: -22.06% <br />New Amount $38,968.33 <br />Total Percent of Change: -22.06% <br />Dispersal After Approval <br />Copy Original <br />n n <br />El El <br />