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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11/21/2018 <br />Amv Shirk <br />Department Admin & Finance <br />BPW Date 12/11 /2018 Phone Extension 9133 <br />Re uireo Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Check the 4 <br />II Agreement <br />❑ Professional Services <br />Bid Opening <br />E:1 Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />1 Other: D'isnosat <br />iropriate Item Type - <br />Contract <br />Amendment <br />❑ Bid Award <br />❑ Quote Award <br />❑C/O &PCANo. <br />FJ Traffic Control <br />Company or Vendor Name <br />New Vendor ❑ Yes <br />No <br />MBE/WBE Contractor ❑I MBE <br />❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />'for All Submissions <br />Proposal F-1 Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Information <br />Resolutionqq - c�c)j <br />Claim <br />If Yes, Approved by Purchasing <br />Completed E-Verify Form Attached ❑ Yes <br />❑ No <br />Forian a Orders Orni <br />Amount of E Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: _ <br />New Amount $ <br />Total Percent of Change: <br />Time Extension: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />1-1 <br />El <br />