Laserfiche WebLink
4/14 01 Jenni er orle -Agenda equest Form--He--. oc -pa—e <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Aril 14, 2011 <br />De artment <br />En ineerin <br />BPW Date <br />April 25, 2011 <br />Phone <br />235 -5933 <br />Name <br />John Engstrom <br />U Quote Opening <br />(I Quote Award <br />Requir Legal (Z Attorney Name - <br />e Controller Controller review is required for all Contracts $5,000.00 or more <br />Prior and greater than one year in length per the City Purchasing <br />to Policy <br />u mi Other Appropriate Reviewers I, - <br />ttal to <br />Check the Appropriate Item Type - Required for All Submissions <br />_ Agreement <br />lC?7,Contract (XPro osal 17 Addendum <br />C Claim <br />❑ Bid Opening <br />U Bid Award I? Re . to Advertise n Title Sheet <br />U Quote Opening <br />(I Quote Award <br />1✓ Chq Order No. <br />L C/O & PCA No. <br />h PCA <br />G Ease. /Encroach. <br />11 Traffic Control <br />17 Resolution <br />rl Other: <br />Required Information <br />Company or Vendor Name <br />Ken Herceg & Associates /Revised from last meetin <br />New Vendor <br />t7 Yes IX No ❑ If Yes, Approved ?Y Purchasing <br />Project Name <br />Training Center Sewer & Water Extensiont <br />Project Number <br />109 -011A <br />Funding Source <br />EMS Capital Fund <br />Account No. <br />E.M.S.C.I.P. #288000- 341 -03 -00 <br />Amount <br />$ 15,000 <br />Terms of Contract <br />Purpose /Description <br />Enaineering services to extend sewer and water to the <br />southeastern corner of the proposed Training Center <br />For Change Orders Only — <br />Amount of <br />L7 <br />Increase <br />$ <br />ri <br />I Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of <br />Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />L <br />0 <br />