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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/12/2019 <br />Name ... To Villa Department Enaineerin <br />BPW Date 09/24/2019 Phone Extension 5920 <br />MMMMMMM�N� <br />W.W. ------- .......... <br />Required" - Prior_ -., <br />Submittal to Board <br />Legal F1 Attorney Name <br />Controller El 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 />[J Agreement <br />El Professional Services <br />[:] Bid Opening <br />El Quote Opening <br />[:1 Change Order No. <br />EJ Ease/Encroach. <br />Other- <br />iropriate Item Type - <br />El Contract <br />F-1 Resolution <br />R Bid Award <br />El Quote Award <br />C/O & PCA No. <br />❑ Traffic Control <br />for All Submissions <br />I Proposal mITITmmmITITmmmmmmWW Addendum <br />R Req. to Advertise El Title Sheet <br />ired Information <br />Company or Vendor Name Dudeck Roofing and Sheet Metal <br />New Vendor [:] Yes 0 No EJ If Yes, Approved by Purchasing <br />MBE/WBE Contractor E] MBE F-1 WBE <br />MBE/WBE Contractor Requested [] No F-1 Yes Name of Company <br />Project Name Gemini Was_ -Colfax Apartment Improvements <br />Project Number 11 8-080A <br />Funding Source West Washinqjop_TIF..... <br />Account No. 422-1050-460-42.03 <br />Amount � 133,295.00 <br />Terms of Contract <br />Purpose/Description Proiect Closeout. <br />El Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verifv. Iran. etc, <br />uired For Change, Orders On <br />Amount of Increase $ ' 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 />El <br />F-1 <br />El <br />F-1 <br />n <br />El <br />