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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/18/2019 <br />.._.. <br />. Department Code Enforcement <br />�... _.... <br />Name Adam Parsons <br />Division/Bureau <br />BPW Date 2/26/2019 <br />�MWfYCy vwc �NC:�llfl'�NYIWIW'il IPI'�I'�INININIIWIIWIIIIIINIflININININfT1WlmNIN�4�IIIINONINII�NINIIN1161W�IF�PWI@I�WAT�NIMININIIIIIIWWWI�':�I <br />......... ... ...... <br />Phone Extension 9302 <br />WWWWWI°'WWIVIMIIIWIVWVWYuYi�M1:�Wl I�pUVNIVWPoIN Ni �' � �� UrTiRRN1NpUPxOGl1WWiTIGr1;;'WNIR�fl�ii I'M!W' . <br />.. W.,.........w.�,.,..w.,.. <br />......._ ..... <br />.. �,,... ,,,,. "" gym... �� . ..........�..... ............. ,...., <br />Required Prior to Submittal to Board .. <br />Legal ❑ <br />Attorney Name: Clara McDaniels <br />Controller ❑ <br />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 />mm Check the AppropriateItem Type ww wwRequired for Submissions <br />L1 Agreement Amendment <br />El Contract ❑ Proposal 0 Addendum <br />Professional Services <br />Resolution <br />El Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />0 Quote Opening <br />® Quote Award <br />[] Change Order No. <br />❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control: <br />[� Other: <br />........................................�____._.�.�....___..__......... �___._______.�_.m._. Reauire.'...Information <br />Company or Vendor Name <br />Brown & Brown General Contractors„ Inc. <br />..._ <br />__.............................................. ........ <br />Yes [>—,I, No El If Yes, Approved by <br />New Vendor <br />Purchasing <br />MBE/WBE Contractor <br />❑J <br />�._............... ........... ..........._W............. <br />MBE L-] WBE <br />MBE/WBE Contractor Requested <br />❑ <br />No EJ Yes Name ............._. � . <br />of Com an <br />Project Name <br />Code Enforcement Office Improvements ................... <br />Project Number <br />18-019............................................................. <br />Funding Source <br />Code Enforcement <br />Account No. <br />600-1201-415.39-89 <br />Amount$4, <br />776.00 �..-�._..�._�.��....�................................................_...........�. <br />Terms of Contract <br />....._._...........��. .... <br />Lump Sum <br />Purpose/Description <br />. omm d .. <br />Ins ector area to accommodate Hum <br />-Updatep be.. of emplo-Tees <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />__ ... .�yir d For Chan e Orders Only <br />Amount of <br />[] <br />Increase <br />Decrease <br />$ <br />$ <br />PreviousAmount$.........................................................� <br />�......... <br />. <br />............. <br />_.......... <br />. <br />Current Percent of Change: %ww <br />New Amount $ <br />Total Percent of Change: %°... ... _...._.._...................... <br />_............. <br />....... <br />.................... <br />_......... <br />_-.......... <br />Dispersal After Approval......_......._....._._.......�.._.._.__ <br />Copy Original <br />® F-1 Tracy Skibins — Director, Code Enforcement <br />. ............. <br />Conn � Ron O'Director of Finance, <br />® �] er — Hance, Code Enforcement <br />