Laserfiche WebLink
Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />October 15, 2018 <br />le Silveus <br />Department Engineering Incernng__ <br />BPW Date October 23, 2018 Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal F-1 Attorney Name <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing 11 <br />Check the Appropriate Item Tvnp — Pon ired forAll Submissions <br />El:Agreement F Contract EProposal EAddendum <br />E] Professional Services F1 Resolution <br />0 Bid Opening El Bid Award Z Req. to Advertise Z Title Sheet <br />F1 Quote Opening El Quote Award <br />F Change Order No. F C/O & PCA No. ❑ P CA <br />F1 Ease/Encroach. ❑ Traffic Control <br />Othe: <br />Reauired Information <br />Company or Vendor Name <br />New Vendor <br />MBENVBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />TBD <br />El Yes El No El If Yes, Approved by Purchasing <br />F-IMBE E] WBE <br />Wayne St. Markin V, Garage Roof Replacement <br />118-096A <br />RWDA <br />324-1050-46042.02 <br />$ TBD <br />Terms of Contract Base Bid plus Alternates <br />Purpose/Description Roof Repairs to the Existing Parking Garage Towers and Canopy <br />F-1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of F] increase $ <br />[] Decrease <br />Previous Amount <br />Current Percent of Change: % ❑M a ✓ <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Origina <br />FI <br />F1 <br />1:1 <br />F-1 <br />E] <br />El <br />