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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/17/2018 Department Public Works <br />Name W. To V i l Division/Bureau Engineering <br />......... <br />BPW Date 12/20/2018 Phone Extension 5920 <br />_...._� ..... ...._.._......... _..._......................... <br />Legal ❑ Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />El Agreement Amendment <br />0 Professional Services <br />❑ Bid Opening <br />E Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />IL Other: <br />Company or Vendor Name <br />iropriate Item Typemm-.mRegb <br />E] Contractm mmmmmmmm <br />El Resolution <br />Bid Award <br />F1 Quote Award <br />® C/O & PCA No.5 Final <br />❑ Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />for All Submissions <br />Proposal <br />E] Req. to Advertise <br />uired Information <br />Insituform Technologies <br />Project Closeout <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iramn,metc. <br />... <br />Required For Chance Orders Only <br />Amount of ® increase Decrea a �_$....1..62. 5.3�8...7............................_�........................ <br />..� <br />Previous Amount $ 2,999,734.00 <br />Current Percent of Change: 5 42% <br />New Amount - ---............................................. .�_�_ <br />2,837,196.20 <br />_._m .. ww�....... <br />Charge <br />Total <br />Percent o-4.08%mm ,�,... �._ .. ........�............ <br />Discersal After Approval <br />Copy <br />Original <br />El <br />❑ <br />