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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Lory Timmer <br />Department DCI <br />BPVV Date 812,8/18 Phone Extension 5841 <br />............ ..... . ..... <br />Legal <br />Controller <br />Purchasing <br />Che, <br />Agreement <br />n Professional Services <br />El Bid Opening <br />L] Quote Opening <br />F-1 Change Order No. <br />❑ Ease/Encroach. <br />Other: Amendment <br />Attorney Name Clara McDaniels <br />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 />Contract <br />El Resolution <br />F-1 Bid Award <br />F1 Quote Award <br />El C/O & PCA No. <br />[:] Traffic Control <br />Proposal <br />El Req. to Advertise <br />am <br />Company or Vendor Name Department of Community Investment <br />New Vendor El Yes M No El If Yes, Approved by Purchasing <br />MBENVBE Contractor F-1 MBE R WBE <br />MBEANBE Contractor Requested M No F-1 Yes Name ofCompany <br />_ <br />Project Name Emergency Solutions Grant (ESG) Administration <br />Project Number 18-JE-01 <br />Funding Source <br />Account No,. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Emergency Solutions Grant (ESP) <br />212.1001.460,3930 <br />$3,945 <br />F.115 1114 1% 1 TO <br />F-1 Title Sheet <br />1/01/18 — 12/31/18 <br />Subsidize DCI staff costs for administerin Emer enc Solutions <br />Grant <br />H Required Contractor's Certification Form Attached (Non- <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran:, etc. <br />Amount of F-1 Increase $ <br />R Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Copy Original <br />n Judy Love <br />❑ El <br />El 11 <br />Dispersal After Approval <br />