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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/14/2019 <br />Department <br />Name....... _ Toy Villa, �� Iniineerin .— .............— <br />BPW Date 05/28/2019 Phone Extension 5920 <br />n�� i rmu. m, �+ i IIP'1XfA 4NNNNNIW W <br />cc u�_Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />,,.---- <br />Purchasing <br />Check the A <br />� <br />ate Ite __._.. m Tyl c — equireda16r All Submissions <br />❑ Professional Services Agreement Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />Quote Opening <br />E] Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />0 Chg. Order, No. <br />Traffic Control <br />F] Other: <br />uired Information <br />Company or Vendor Name Herrman & C3octz, Inc. <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 />j Proposal <br />El Special Purchase, QPA <br />El Req. to Advertise <br />E] Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />LJ Yes LJ If Yes, Approved by Purchasing <br />No <br />E] MBE MBE Completed E-Verify Form Attached El Nos <br />Fire Station 10 & I Equip ment............................................................... <br />...��_�_ <br />118-108 _ <br />Equipment wPurchases/ Materials & E ui ment <br />,.... T ..�. m.�. _� .. <br />287.0902.422.43.10 <br />$47,287.00 <br />—Project—Closeout <br />... ... <br />For Chang_ Orders Only�� <br />__... ....... m .�®��._......� ._........_.�w_ <br />Amount of Increase $ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />......Increase........ <br />w...._.�. <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />