Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Name Alicia Czarnecki <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 04/10/2018 Phone Extension 5903 <br />Required Prior to Submittal to Board <br />Legal F-1 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 El <br />Check the Appropriate Item Type — Required for All Submissions <br />F1 Agreement Amendment ❑ Contract n Proposal ❑ Addendum <br />n Professional Services, Resolution <br />F1 Bid Opening El Bid Award 0 Req. to Advertise Title Sheet <br />EJ Quote Opening El Quote Award <br />El Change Order No. El C/O & PCA No.. F] PCA <br />F] Ease/Encroach. ❑ Traffic Control: <br />0 Other: General Release Reauired Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE 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 />TBD <br />E-1 Yes F No ❑ If Yes, Approved by <br />Purchasing <br />[:1 MBE [:1 WBE <br />F1 No El Yes Name of Company <br />Ravina Park <br />117-073 <br />FIRequired Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of E] Increase $ A DJ51�rj jjptp <br />El Decrease $ <br />Previous Amount $ _.w VV <br />Current Percent of Change: % APR 10 ' 111k, 1 /7 <br />New Amount $ 7� <br />WOM <br />Total Percent of Change: % <br />Disr)ersal After ftorozWASUP, -MIA A= <br />Copy <br />Original <br />N <br />11 <br />M <br />F-1 <br />R <br />R <br />Kara Boyles, City E <br />Alicia Czarnecki <br />ineer <br />