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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/06/2018 <br />Name wPatrick Sherman <br />Department VPA: Facilities & <br />Grounds <br />BPW Date 12/11/2018 Phone Extension 5601 <br />m smmnmmnmmmmmmmmmri ✓,muuuuuumummwuw.rawaa emaeuP m... wy. MME51miumEffoowm'ummm yam <br />�_....�...,.... � IT�w_ R� uired Prior to Submittal to Board <br />g ® Attorne 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 Schmidt <br />Check the <br />Agreement <br />] Professional Services <br />Bid Opening <br />El Quote Opening <br />Change Order No. <br />[ Ease/Encroach. <br />Other: QPA Purchase <br />Tq riate Item T r ems— Rq uir for All Submissions <br />issi <br />Contract Proposal <br />Resolution <br />Bid Award D Req. to Advertise <br />D Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />Rewired Information <br />Company or Vendor Name Gametime Inc. <br />New Vendor El Yes M No F-1 If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE [:] WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />ProjectPpg.r es Pro ram: Phase 2 <br />mm_Project Number10762018g <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />El <br />Addendum <br />❑ Title Sheet <br />Park Bond Series I <br />471-1137-452.42-01 <br />_214,802.60 _ <br />QPA Purchase: US Communities Contract #201#2017001�134 <br />QPA Purchase of la round a ui ment as art of2� 019 arks <br />upgrade pro ..ram <br />El Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv, Iran, etc.) <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />F-1 <br />❑ <br />❑ <br />Dispersal After Approval <br />