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BOA1U) OF PUBLIC WORKS <br />AGENDA ITEM REVIEW RE,QUEST FORM <br />Date 0�9/04/2018 Department <br />Name Toy Villa Division/Bureau <br />BPVV Date 09/1'1 /2018 Phone Extension <br />al MIRY Me <br />Legall El 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 El <br />H Agreement <br />El Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />F1 Change Order No. <br />❑ Ease/Encroach. <br />❑ Other: <br />Company or Vendor Name <br />LJ Contract <br />F-1 Resolution <br />El Bid Award <br />F-1 Quote Award <br />0 C/O & PCA No.1 (Final) <br />F-11 Traffic Control: <br />New Vendor <br />MBENVBE 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 />040 Z - 11916HEMKIre MIMMI IM11 <br />WMIM <br />Addendum <br />El Req. to Advertise El Title Sheet <br />AEM <br />F1 Yes M No <br />Purchasing <br />[] MBE F] WBE <br />El No 0 Yes Name of Compa <br />Fellows Street Raised Crosswalk <br />117-086 (15J008) <br />RWDA <br />324-1050-460-42.03 <br />If Yes, Approved by <br />Project Closeout <br />[:] Required Contractor's Certification Forms Attached (Non-, <br />Collusion, Non-Discrimnation, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of H Increase $2,3,46.12 <br />El Decrease $ <br />Previous Amount, $ 104,092.50 <br />Current Percent of Change: 2.25% <br />New Amount $ 106,438.62 <br />Total Percent of Change: 2.25% <br />Copy <br />Original <br />El <br />F-1 <br />F-1 <br />F-1 <br />El <br />El <br />