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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 8, 2019 <br />mm Department Admin & Finance - <br />Name Maricela Juarez & Roxanne Lawson Water Works <br />BPW Date 01/28/20 Phone Extension 9953 <br />. .. . ........ . <br />Required Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ❑ <br />Checkmmmthe A <br />LJ Agreement <br />F-1 Professional Services <br />❑' Bid Opening <br />F-1 Quote Opening <br />F-1 Chg Order No. <br />El Ease./Encroach. <br />,Z- Other:.P4R2§#9Pig <br />0- <br />Und,ateA,,a,Re "art <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />!E9priate Item Type . .... Re Uired for All Submissions <br />Contract Proposal <br />El Amendment <br />El Bid Award El Req. to Advertise <br />El Quote Award <br />C/O & PCA No. ❑ PCA <br />Traffic Control M-Resolution <br />Claim <br />Reauired Information <br />Addendum <br />F-1 Title Sheet <br />—Ye's', if —Yes . .......... A p—proved -b" y —Purch'a—sing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />WBE n No <br />Amount of Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change- % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Copy <br />Original <br />Z <br />1:1 <br />F-1 <br />El <br />El <br />D <br />Dispersal After Approval <br />Maricela Juarez <br />