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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 26, 2018 <br />Name Pam Meyer Department DCI <br />BPW Date December 11, 2018 Phone Extension 5845 <br />�w������wuu�rteu�mmyrvm nr� � mwmm�mw � �imimau mmmmmmmmi�um �aarmaaam�r�rr�umumuum imimm�mmimmuuuuuuuuuuuuuuuuuuuuuuuuuuummuuuuuuwnr�mimm� <br />red Prior to Submittal to Board <br />Legal ® Attorney Name Sandra Kennedy <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />LJ Agreement <br />❑ Professional Services <br />Bid Opening <br />❑ Quote Opening <br />El Change Order No. _ <br />El Ease/Encroach. <br />El Other: <br />itopriat Item Type �qqire f for All Submissions <br />❑ Contract 0 Proposal <br />Addendum <br />® Resolution <br />El Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />El Quote Award <br />El C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />R#gyired Information <br />,,,..�.. <br />Company or Vendor Name <br />p y <br />.................. � _�-....... <br />Urban En ........_._._._.. ....................... <br />Enterprise Association of South Bend, <br />Inc. <br />New Vendor <br />E] Yes Z No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />N/A <br />Project Number <br />N/A <br />Funding Source <br />.......� �,.._ ....� <br />N/A <br />Account No. <br />N/A <br />Amount......�000 <br />......................................m......m.....,.......a��� ,e.......ee......... �...........,�� <br />Terms of Contract <br />. <br />_......................................................................�w�w.... mm..�.�.�..............................................................�_� <br />N/A <br />Purpose/Description <br />Transfer of Property ( vacant lots) to City <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination„ Non -Debarment, E-Verif ,Iran, etc. <br />Required For Canoe Orders Only <br />Amount of El increase $ <br />EJ Decrease $ <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy Original <br />® ® Pam <br />� ................. <br />EJ F <br />11 El <br />Dispersal After Approval <br />, DCI <br />