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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />08/08/2019 <br />Patrick Sherman <br />Department VPA: F&G <br />BPW Date 08/13/2019 Phone Extension 5601 <br />Required Prior to Submittal to Board <br />_w ...... ...._�...w �. �� ....... ...... <br />Legal ® Attorney Name Clara McDaniels <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 ® Michael Schmidt <br />Check the <br />Agreement <br />Professional Services <br />❑ Bid Opening <br />F-1 Quote Opening <br />El Change Order No. <br />E Ease/Encroach. <br />FOther: <br />�ropriate Item, Typemm- <br />El Contract <br />Resolution <br />El Bid Award <br />Quote Award <br />❑ C/O &PCANo, <br />❑, Traffic Control <br />for All Submissions <br />I Proposal <br />❑ Req. to Advertise <br />Information <br />❑ PCA <br />mmAddendum <br />❑ Title Sheet <br />Company or Vendor Name Recreation inSites LLC <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Pulaski Park Playground_ <br />Project Number 1094-2019 <br />Funding Source Park Bond Series I <br />Account No. 471-1137-452.42-01 <br />Amount 7 Lf 9 <br />Terms of Contract Omnia QPA Contract #2017001135 <br />Purpose/Description New <br />....Playground at Pulaski Park <br />.......___�._�_.m.......... w...� .._. <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination,_ Non -Debarment, E-Verify, Iran, etcmwwwwwwwwwwww <br />wired For Charge Orders Orly <br />Amount of Increase $ mm y <br />Decrease <br />Previous Amount $ <br />