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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 15, 2018 <br />Jeff Hudak <br />Department Central Services <br />BPW Date March 27, 2018 Phone Extension 235-9316 <br />Required uired Prior to Submittal to Board <br />Legal ® Attorney Name Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000,00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing Z Michael -Schmidt <br />Check the. Ap prop ` riateItem T e'' Re' aired for All Submissions:.:... <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />:::Required Information <br />Company or Vendor Name <br />New Vendor <br />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Spec M. - One (1) or More 2018 or Trash Tote Cleaning Trailer <br />Project Number. <br />Funding Source <br />2018 Solid Waste Capital Lease Budget <br />Account No: <br />611-0610-415.37-11 _ <br />Amount <br />$ <br />Terms of Contract <br />_ <br />Purpose/Description <br />Bid Opening Date: <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Re aired ForChan` e Orders Only..:. <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: % <br />New Amount <br />$ <br />Total Percent of Change: % _ <br />Dispersal After Approval <br />Copy Original <br />® ❑ <br />Jeff Hudak <br />® ❑ <br />Mike Bronstetter <br />❑ ❑ <br />