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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />8117/18 <br />Jeff Hudak <br />Department Central Services <br />❑ Agreement <br />❑ Contract <br />U Proposal U Addendum <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Bid Award <br />® Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ CIO & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />I-1 Other: <br />❑ Claim <br />Company or Vendor Name <br />New Vendor <br />MBEMBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑Nos <br />Spec V - 2018 or Newer 50 Ton Paver Special Trailer <br />202-0607-431-3711 Principal & 202-0607-431-3712 <br />Interest <br />2018 Street Department Capital Lease Principal & Interest <br />Purpose/Description Bid Opening Date: <br />For Chan e Orders Can[ - <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />® <br />❑ <br />❑ <br />❑ <br />Terri Swift, Street Department <br />Jeff Hudak, Central Services <br />