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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />01 /17/2019 <br />Patrick Sherman <br />Department VPA <br />BPW Date 01/22/2019 Phone Extension 5601 <br />imw��uuuuv immmmm PPPPuimimuuuuuuuuuuuuuuuuw a m�mmmmmmmmmmmm�nmmwmmmmmmmmmmmmmm mre <br />........ _.... _...,,w,...__._.._ ..... .. .....�......._�. .............. _....w....... <br />Req fired Prior to Submittal to Board <br />mmITITm ._.. ITITmm <br />Legal ® Attorney Name Clara McDanielsm-mmmIT mm WW <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® Michael Schmidt <br />Check the i <br />Agreement -.__.............................. <br />Professional Services <br />❑ Bid Opening <br />Quote Opening <br />El Change Order No. <br />Q Ease/Encroach. <br />0 Other: P°A Purchase <br />ir rriate Itom T pe . <br />El Contract <br />❑ Resolution <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo. <br />_ <br />El Traffic Control <br />Required Information <br />Company or Vendor Name Gametime Inc. <br />for All Sul <br />Proposal <br />Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />New Vendor <br />❑ Yes Z No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE [:1 WBE <br />MBE/WBE Contractor Requested <br />❑ No ❑ Yes Name of Company <br />Project Name <br />Park Upgrades Program: Phase 3 <br />Project Number <br />1076-2018B <br />Funding Source <br />Park Bond Series I._.___........� <br />Account No. <br />471-1137-452.42-01 <br />Amount <br />$ 370,378.63 <br />Terms of Contract <br />Q.�......._...................._.� <br />PA Purchase: US Communities Contract #2017001134 <br />Purpose/Description <br />QPA Purchase. l ....... � .. of playground a ui ment as art of 2019 parks <br />upgrade program <br />Required Contractor's Certification Form Attached (Non - <br />__.. WW�.... <br />Collusion, Non -Discrimination, Non -Debarment, E-Verif , Iran, etc. <br />..... <br />Required For Chancie Orders Oni <br />Amount of Increase $ <br />Decrease <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />F] <br />❑ <br />El <br />❑ <br />