Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/03 /2019 v �.. .�.... <br />Department VPA: Facilities & <br />Name Patrick Sherman Grounds <br />BPW Date 0710612019 Phone <br />rrmnnommmam Re uired Prior to�� Su����b�_m.mw.._ittal to BoEaxrdtension .�56.....0......1 <br />mmmmmMPEMPHIMmmmmmmmmmEm imw....... .... <br />Imamawsm— <br />Legal Attorney <br />Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />Ease/Encroach. <br />F-1 Other: <br />Michael Schmidt <br />roprriate Item Type IT fie ired for All Submissions <br />El Contract El Proposal <br />F-1 Resolution <br />F� Bid Award ❑ Req. to Advertise <br />® Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />Required Information <br />Company or Vendor Name Carnet Service Outlet <br />New Vendor ❑ Yes E No R If Yes, Approved by Purchasing <br />MBE/WBE Contractor MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name Erskine Clubhouse Basement Flooring <br />Project Number 1087-2019 <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of...�.�._..._...�.�.................... �._..���.....................................aww�w .. . <br />Increase <br />❑ <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />El <br />❑ <br />El <br />El <br />Facilities & Grounds Maintenance <br />- ................ ................. <br />0-1101-452.39-89 <br />$ 9,995.00 <br />Completion in 45 calendar days <br />Addendum <br />❑ Title Sheet <br />Installing flooring in Erskine Clubhouse Basement <br />Z Required Contractor's Certification Form Attached (Non - <br />Collusion„ Non -Discrimination, Non -Debarment E-Verify, Iran, etc. <br />uired For Change Orders Oniv <br />Dispersal After Approval <br />