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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 17, 2020 <br />Maricela Juarez & Renata Department Admin & <br />Name Matousova Finance/Police <br />BPW Date 08/25/2020 Phone Extension 9953 <br />m m � rmrm <br />......,......_...... .......... ..... _..... <br />Reauired Prior to 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 Appropriate Item Twe — Reauired for All <br />Agreement <br />L,,,J Contract <br />LJ Proposal ❑ Addendum <br />❑ Professional Services <br />❑ Amendment <br />❑ Bid Opening <br />El Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />F-1 Traffic Control <br />❑ Resolution <br />® Other: <br />❑ Claim <br />Dis osal/Scra /Trade -In <br />3 Police Vehicles <br />E __-- <br />_ <br />Required Information <br />Company or Vendor Name <br />New Vendor Yes <br />No <br />MBE/WBE Contractor F-1 MBE <br />Fj 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 />�or:�h� Qrders �1 <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 />D <br />El <br />Dispersal After Approval <br />Maricela Juarez <br />