Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 31, 2018 <br />Department Public Works <br />Name Scott Kreeger Division/Bureau Engineering <br />BPW Date November 13, 2018 Phone Extension 9245 <br />...... �.. ..._._............................. Re uire _._.. <br />� Submittal to Board <br />.....�.... __._............._.__ ��.............��...��.._...... �_�� d Prior to �..�....._. .a....... ... _ �....�� <br />Legal ® Attorney Name: Clara McDaniels <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 ❑ Michael <br />Schmidt <br />��_............... �_ ._........_ . .._.._. <br />Check the Appropriate <br />_..... _._.. ._......_..................... ....—...... ....... <br />Item Type — Required for All Submissions <br />❑ Agreement Amendment [] <br />Contract ❑ Proposal Addendum <br />[� Professional Services [-] <br />Resolution <br />Bid Opening ❑ <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Opening E] <br />Quote Award <br />Change Order No. <br />C/O & PCA No. ❑ PCA <br />El Ease/Encroach. <br />I Traffic Control: <br />M Other: Receipt of cr000sa <br />Required Information <br />H Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />. <br />Required For Change Orders Only mmm-__........ ..� ........._ <br />Amount of El Increase $ ....n ...m�._._�.........,,,._�.���. ...... <br />❑ Decrease $ <br />Previous Amount $ <br />Current Percent of Change — <br />New Amount $ <br />