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6F (1)
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05-31-12 Packet
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11/1/2012 10:06:28 AM
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5/25/2012 12:10:18 PM
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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 23, 2011 Department C &ED <br />BPW Date July 11, 2011 Phone 235 -5842 <br />Name Bill Schalliol <br />RevMr X into ;M Ion <br />1. <br />Com I p a , ny or Vendor Name <br />Agreement <br />El Contract <br />Proposal <br />Addendum <br />Claim <br />No <br />El <br />Bid Opening <br />Project Name <br />Bid Award <br />SR 23 and Douglas Added Right Turn Lane Project <br />Reg. to Advertise <br />Title Sheet <br />Not y et assigned) <br />Quote Opening <br />Funding Source <br />Quote Award <br />DREDA TIF <br />Chg Order No. <br />Account No. <br />C/O & PCA No. <br />PCA <br />Amount <br />Ease. /Encroach. <br />$ 28,900.00 <br />Traffic Control <br />Terms of Contract <br />Resolution <br />❑ <br />Other: <br />Purpose /Description Design service proposal for SR 23 and Douglas Added Right <br />Turn Lane Proiect. <br />W, ar Y " 6 '• {,� . 1 t k y^ '. n' k^ ,' ::'i Y >. �x an YJn, 1 <br />+ <br />Amount of <br />RevMr X into ;M Ion <br />1. <br />Com I p a , ny or Vendor Name <br />Abonmarche <br />New Vendor <br />Yes <br />No <br />El <br />If Yes, Approved by Purchasing <br />Project Name <br />SR 23 and Douglas Added Right Turn Lane Project <br />Project Number <br />Not y et assigned) <br />Funding Source <br />DREDA TIF <br />Account No. <br />Amount <br />$ 28,900.00 <br />Terms of Contract <br />Purpose /Description Design service proposal for SR 23 and Douglas Added Right <br />Turn Lane Proiect. <br />W, ar Y " 6 '• {,� . 1 t k y^ '. n' k^ ,' ::'i Y >. �x an YJn, 1 <br />+ <br />Amount of <br />❑ <br />❑ <br />Increase $ <br />Decrease $ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />PO No. <br />rea Af #fit AA#ro�:., <br />Copy Original <br />❑ Z Roger Nawrot, Abonmarche <br />z ❑ Bill Schalliol, CED; Carl Littrell, Rob Nichols, Engineering <br />
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