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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />09/03/2019 <br />Kieran Fa <br />Department Public Works <br />BPW Date 09/10/2019 Phone Extension 5993 <br />IVIVIVIVII'dN PrkRP�F�MY�WNNIWN@WIIIIIIII' � ,, ,, �6YJl�iA' Imp""^"" MAW!911 �. YIYI �,iIMIDd�NVNMPrt <br />Required Prior to Submittal to Board <br />Legal® Attorney Name Clara McDaniels <br />Controller ❑' Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the <br />LJ Agreement <br />® Professional Services <br />j] Bid Opening <br />El Quote Opening <br />E:1 Change Order No. _ <br />Ease/Encroach. <br />El Other: <br />wrprt Item T <br />El Contract <br />Resolution <br />F] Bid Award <br />EJ Quote Award <br />�] C/O & PCA No, <br />Traffic Control <br />for All Submissions <br />I Proposal ❑ Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />Required Information <br />Company or Vendor Name: Umbau h now known as Baker Till <br />❑ PCA <br />New Vendor ❑ Yes ® No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name LTCP capital funding plan <br />Project Number NA <br />Funding Source_��...�_..........._.Wastewate.r.�.�.......�W_� _._�.�.�...........�.�_.� mm.�....�.._. <br />..............Ww m.............. _w �.�.........._ <br />Account No. _ 641-0630-793-31-01 <br />$ 60,000 Not to be exceeded <br />Amount <br />Terms of Contract <br />Purpose/Description Financial adviso services <br />EJ Required Contractor's Certification Form Attached (Non - <br />Collusion., Non -Discrimination, Non -Debarment, E-Verifv„ Iran. etc. <br />Amount of Increase mm $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />