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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01 /24/2019 Department Public Works <br />Name Toy Villa Division/Bureau Engineering g ring <br />BPW Date 02/12/2019 Phone Extension 5920 <br />ie��rired Prior to Submittal to Board <br />Legal F] Attorney Name: <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing El <br />_ Check the <br />❑ Agreement Amendment <br />0 Professional Services <br />El Bid Opening <br />Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />iropriate Item T_y <br />El Contract <br />R Resolution <br />Bid Award <br />❑ Quote Award <br />® C/O & PCA No <br />❑ Traffic Control: <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />R <br />_qqlqd for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />1 Final R PCA <br />uired Information <br />K & R Tree Service <br />Addendum <br />❑ Title Sheet <br />Purpose/Description Project Closeout <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination Non Debarment E-Verify, Iran, etc. <br />....... _ ._____ ._. N <br />Amount of .... _�.. .....�... __...... <br />Ro iuired For Chan, Orders Orja�r <br />® Increase $ 1mm„840.00 <br />❑ Decrease $ �.s___..——_m._...... ........._ <br />Previous Amount $ 15,625.00 <br />CurrentPercent of Change: 1...1...78.%9.... _ _ ................��... m..��.........................��......�. ���� ���A...A�.�.�.�.�.�......_. 6 <br />New Amount _$ 17,465.00 <br />Total Percent of Change: 11.78% ����- ......._._ ............. � <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />El <br />❑ <br />❑ <br />