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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1 /� 18 Villa ..m �� ......�.e�.. <br />Name Joy Department Engineering <br />BPW Date 12/20/2018 Phone Extension 5920 <br />pro A��,row��r�r�rvvu nu�eruv�w... iwuwmmmuumdammwomommmuuwumwiwmwiwmuwuu�uuuuuuuuu�muuuumuwrmm��mrrmmm... .. mmomom mmu,�.wmumim�mm <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />F-1 Quote Opening <br />fA Change Order No. 1 <br />[l Ease/Encroach. <br />0 Other: <br />iroriate Item �w mm <br />Contract <br />❑ Resolution <br />❑ Bid Award <br />El Quote Award <br />[:] C/O & PCA No. <br />F-1 Traffic Control <br />Required Information <br />for All Submissions <br />..............� .�...... ....... <br />I Proposal ❑ Addendum <br />Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />Company or Vendor Name Walsh & Kelly, Inc. <br />New Vendor ❑ Yes ® No E:] If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Great Lakes Capital Spec Building___ .. <br />Project Number 118-058 <br />Funding Source RWDA TIF <br />Account No. 324.1050.46042...0�4......................................................................................... <br />�.... �-_ . <br />Amount$ ���. ................�..w.....w ___... <br />Terms of Contract <br />Purpose/Description Approval of C.O. #1 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran„ etc. <br />red'' For Change Orders On <br />Copy <br />Original <br />❑ <br />