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I - W11 - <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />10102/18 <br />Sue Ellen Doud'rick <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 10109/18 Phone Extension 5992 <br />Required Prior to Submittal to Board <br />Legal El Attorney Name- Clara McDaniels <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 F1 Michael Schmidt <br />Check the Appropriate Item Type — Reequired forAll Submissions <br />F-1 Agreement Amendment [:] Contract ❑ Proposal El Addendum <br />F1 Professional Services F-1 Resolution <br />Q Bid Opening ❑ Bid Award Req. to Advertise Title Sheet <br />El Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No.. E] PCA <br />❑ Ease/Encroach, ❑ Traffic Control: <br />F1 Other- <br />Reauired Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />0 Yes [:1 No F-1 If Yes, Approved by <br />Purchasing_ <br />[:1 MBE [] WBE <br />F-1 No El Yes Name of Company <br />"Three Twenty Cascades"- Site Utilities <br />I § R] Elyz I W, <br />Funding Source River East TIF <br />Account No. 429 <br />Amount <br />Terms of Contract Unit Prices <br />Purpose/Description Construction of site utilities at Three Twenty at the Cascade <br />F Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.,) <br />Required For Change Orders Only <br />Amount of ❑ increase $ <br />Decrease $ <br />Previous Amount $ 0MOVED <br />Current Percent of Change: % tcworm <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval — <br />Copy Original <br />F] F-1 <br />F-1 F-1 <br />1-1 El <br />