Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11 /28/2018 <br />Amv Shirk <br />Purchasing <br />Check the P <br />" Agreement <br />El Professional Services <br />Bid Opening <br />Quote Opening <br />E] Chg Order No. <br />❑ Ease./Encroach. <br />!. Other:Nisr)osal. <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Department Admin & Finance <br />iro riate Item T _q Required for All Submissions <br />❑ Contract F1 Proposal Addendum <br />❑ Amendment <br />El Bid Award Req. to Advertise <br />Quote Award <br />C/O & PCA No. ❑ PCA <br />El Traffic Control Resolution <br />Claim <br />Reouired Information <br />❑ Title Sheet <br />........__. ..... ......... <br />Yes If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached Yes <br />WBE No <br />For Change Orders Only <br />Increase $„ <br />Amount of ElDecrease $ www _....................... ....... �._..._.. <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 />El <br />El <br />