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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 18, 2018 <br />Name Benjamin Dougherty Department Admin & Finance <br />BPW Date December 20, 2018 Phone Extension 7678 <br />..w......... ... . ............. _...... � __ ..� ...__.... .. ......... <br />Re aired Prior to Submittal to Board <br />Legal Elliot Anderson <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 />...___. ....... ...... <br />Check the <br />H Agreement <br />Professional Services <br />Bid Opening <br />El Quote Opening <br />❑ Chg Order No. <br />EJ Ease./Encroach. <br />F Other: <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 />iropriate Item Type — <br />E] Contract <br />❑ Amendment <br />❑ Bid Award <br />EJ Quote Award <br />F] C/O &PCANo. <br />— <br />❑ Traffic Control <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />uired Information <br />Bruce Snyw+ <br />mYes <br />® No <br />MBE <br />❑ WBE <br />2018 CAFR <br />None <br />r <br />PCA <br />Resolution <br />FI Claim <br />If Yes, Approved by Purchasing <br />Addendum <br />❑ Title Sheet <br />Completed E-Verify Form Attached R Yes <br />F] No <br />101-0401-415.31-06 <br />NTE $15,000 <br />Contract for professional services of accounting consultant to <br />assist City in preparation of 2018 Comprehensive Annual <br />Financial Rea rt. ............ <br />For Chanape Orders Only <br />Amount of LJ Increase $ <br />El Decrease $ <br />— ............... <br />_... <br />... <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 />❑ <br />❑ <br />❑ <br />❑ <br />