Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 2, 2018 <br />Name Department <br />,�11�sil_veus 'ng� JL <br />BPW Date Janua '2019 Phone Extension 9083 <br />.._ � .._�R wired Prior to Submittal to Board ._. <br />g Attorney Name <br />Controller D 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 0 <br />(;heck the <br />LJ Agreement <br />El Professional Services <br />E] Bid Opening <br />El Quote Opening <br />F] Change order No. <br />El Ease/Encroach. <br />7 Other: <br />)ropriate ltem <br />0 Contract . .... <br />F Resolution <br />El Bid Award <br />F1 Quote Award <br />El C/O & PCA No, <br />F1 Traffic Control <br />Company or Vendor Name TBD <br />for All Submissions <br />f —Pr"6p —os a I ddendum <br />N Req. to Advertise N Title Sheet <br />ired Information <br />F PCA <br />New Vendor E Yes 0 No E] If Yes, .. Approved by Purchasing <br />MBE/WBE Contractor F1 MBEEI WBE <br />Project Name Main St./Wayne St. Garage Irnpr vernents <br />Project Number 118-09 6R <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />RWDA <br />324-1050-460-42.02 <br />Base Bid Plus Alternates <br />Roof and other Misc. Repairs to the Existing Parking —Garage' Towers <br />..... . ers",' <br />Canopy, and Facade <br />[:1 Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non Debarment, E-Verify, Iran, etc.) <br />Required For Chanqe Orders OnIv <br />Amount of El Decease increase $ <br />F� ease <br />Previous Amount <br />Current Percent of Change: % <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />E] <br />F-1 <br />El <br />❑ <br />El <br />F-1 <br />DisPyI <br />...ersal After Approval <br />