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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />..........20...... 20 <br />Date _ August 17, <br />Maricela Juarez & Renata Department Admin & <br />Name Matousova Finance/Fire <br />BPW Date 08/25/2020 Phone Extension 9953 <br />an 5MMEME ImmmmE rmsn a uimus. <br />Rec t gyred Prior tq.Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the A <br />Agreement <br />Professional Services <br />)ro priate Item Typa — <br />El Contract <br />Amendment <br />'for All Submissions <br />Proposal <br />Addendum <br />Bid Opening 0 Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />Chg Order No. ❑ C/O & PCA No, [ PCA <br />❑ Ease./Encroach. ❑ Traffic Control Resolution <br />® Other: Disposal/ScrapDi§posal/Scrap El Claim <br />Emergency Responder <br />Driver Trainer Simulator <br />quired Information <br />Company or Vendor Name <br />New Vendor U Yes <br />❑ No <br />MBE/WBE Contractor ❑ MBE <br />❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />If Yes, Approved by Purchasing <br />Completed E-Verify Form Attached Yes <br />[ No <br />Far Chan Ur"densI <br />Amount of El 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 />® <br />❑ <br />❑ <br />❑ <br />Dispersal After Approval <br />Maricela Juarez <br />