Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/17/2019 <br />Name Sue Ellen Doudrick <br />Department Public Works <br />Division/Bureau Engineering <br />BPW Date 12/19/2019 Phone Extension 5992 <br />W <br />wwwww�quir-ed Prior to Submittal to Board <br />Legal E] Attorney Name: Clara McDaniels <br />Controller E 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 F] Michael Schmidt <br />Check the <br />F] Agreement Amendment <br />Professional Services <br />Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />iropriate Item Type — <br />Contract <br />Resolution <br />0 Bid Award <br />E Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control: <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 />for All Submissions <br />Proposal <br />.K] Req. to Advertise <br />ired Information <br />❑ PCA <br />Addendum <br />® Title Sheet <br />.. <br />......... <br />El Yes El No ❑ If Yes, Approved by <br />Purchasing <br />❑ mmMBE F WBE <br />[� No [:] Yes Name of Comawr <br />Seitz Park Reconstruction <br />_W. v ..... _...... <br />W <br />Park Bond Multiple Accounts) <br />471.11324523106 45211014523102:45211014524201 <br />Terms of Contract Unit Prices <br />Purpose/Description Phase I of project consist of the North mRiverwalk from Seitz Park <br />to Colfax and South Riverwalk from Jefferson Blvd to the East <br />Race <br />❑ Required C—._.�............... _........_ <br />Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />.......—____�� _ _ <br />Required For Change Orders Only <br />Amount of E] Increase <br />(� Decrease $ e <br />—...... <br />Previous Amount $ —----- <br />Current Percent of Change: % ._._.�. .. t�...�� <br />New Amount $ <br />Total Percent of Change % _ _. <br />Total <br />... _..�t_. Approval ..._. <br />Dispa�l After A <br />�w.. �q� <br />to <br />Original �� <br />