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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />1 /9/2018 <br />Adam Parsons <br />Department Central Services <br />BPW Date 1/22/2018 Phone Extension 9302 <br />��wamm. .. _wvu�u��au �i�i�i��iuwu ,,.... ,v�uuuuuuummmm md�mmImmwww.wwnuaa eaa��redmmmPriorto Sub ... ittal to Board <br />rd <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller Z and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the <br />LJ Agreement <br />n Professional Services <br />[] Bid Opening <br />❑ Quote Opening <br />❑ Chg Order No. <br />❑ Ease./Encroach. <br />11 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 />Michael Schmidt <br />•• <br />LXJ Contract <br />Amendment <br />IF] Bid Award <br />F] Quote Award <br />F] C/O & PCA No <br />❑ Traffic Control <br />— lie erred for All <br />Submissions _......... <br />❑ Proposal <br />[:] Req. to Advertise <br />E] PCA <br />❑ Resolution <br />M Claim <br />Addendum <br />❑ Title Sheet <br />Industrial Door of Northern Indiana <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />Spec AJ — Repair & Installation of Overhead Doors for All City <br />Departments <br />Various Department's Operatinm _Budgets <br />Hourly Rates Attached <br />2019 extension 2018 contract, per the spec _.._...... ... <br />Amount of F] Increase <br />Decrease $ <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 />El <br />0 <br />El <br />El <br />El <br />