Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/18/2019 Department Public Works <br />Name Toy Villa Division/Bureau Engineering <br />BPW Date 06/25/2019 Phone Extension 5920 <br />uuuuuuummu rsRAURNMIMPPPPPMEmmmmmmm�r <br />Required Prior to Submittal to Board <br />Legal ❑jl 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 E <br />El Agreement Amendment <br />to <br />❑ Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Ir1 Other: <br />iropriatewwItem Type — <br />F] Contract <br />El Resolution <br />❑ Bid Award <br />El Quote Award <br />�C/O &PCANo, <br />Traffic Control: <br />Company or Vendor Name <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 />Purpose/Description <br />Amount of F1 Increase <br />R Decrease <br />Previous Amount $ <br />Current Percent of Change, % <br />New Amount $ <br />.................. <br />Total Percent of Change: % <br />Copy <br />Original <br />❑ <br />Fl <br />❑ <br />for All Submissions <br />1 Proposal <br />❑ Req. to Advertise <br />Reauired Information <br />Proiect Closeout <br />Addendum <br />❑ Title Sheet <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination Non -Debarment, E-Verify, Iran etc. <br />uq fired For anrders 91y <br />_......................................................................... _.................................................... <br />