Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 15. 2019 <br />..' . . . . ........ . - ----- <br />Name Daniel BuckenmqyqrDepartment DCI <br />BPW Date January 22. 2019 Phone Extension 5823 <br />MWEENIMPHIM iiiiiiiiiiiiiiiiiiiiiIIWI(M#iii� <br />.......... . . ......... <br />Reqq�iredl Prior to Sybmiftal to <br />. . .... ------ . ......... ....... ... <br />Board <br />Legal Attorney Name Sandra Kennedy <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 />Check the A <br />LJ Agreement <br />F-1 Professional Services <br />Bid Opening <br />Quote Opening <br />❑ Chg Order No. <br />El Ease./Encroach. <br />n Other: <br />Company or Vendor Name <br />New Vendor <br />MBEMBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />iropriate Item Type — <br />X Contract <br />❑ Amendment <br />0 Bid Award <br />0 Quote Award <br />El C/O & PCA No. <br />0 Traffic Control <br />for All Submissions <br />Proposal <br />El Req. to Advertise <br />uired Information <br />PCA <br />Resolution <br />Claim <br />Addendum <br />0 Title Sheet <br />Certstaffix Trayn <br />❑ Yes If es, Approved by Purchasing <br />X No <br />[:] MBE Completed E-Verify Form Attached El Yes <br />F-1 WBE No <br />Pathways On Demand Program <br />EDIT <br />404-1001-460-39.30 <br />$2,150 <br />Purpose/Description Training program to train necessary skills to under skilled workers <br />which will lead to wage increase/job promotion <br />... ...... , For Change Orders Only, <br />Amount of El increase $ . ..... ... ........ .. -- ----- . .... <br />F-1 Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension: <br />Copy Original <br />X 0 <br />X El <br />X 11 <br />Dispersal After Approval <br />Daniel Buckenmeyer, DCI <br />Judy Love, DCI <br />-- -- -- ........... <br />Jacob Alexander, DCI <br />