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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 3, 2020 <br />Department Central <br />Name Jeff Hudak Servies <br />BPW Date Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer El Officer Name <br />BPW Attorney ER Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />ER Michael Schmidt <br />Clara McDaniels <br />I Check the Appropriate Item Tvpe — Reauired for All Submissions I <br />LJ Professional Services Agreement LJ Contract LJ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award [0 Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />F] Other: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ V BE Completed E-Verify Form Attached El ❑ No <br />Project Name <br />Project Number <br />Building Cash 2020 Capital Budget, Code Lease, Water Cash 2020 Capital <br />Funding Source Budget <br />Building 600-13-060-060-445000 <br />Code 230-12-300-100-445000 <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Water 622-06-604-620-445000 <br />Building $100,000 <br />Code $40,000 <br />Water $33,000 <br />Building -Cash. Code -Lease. Water -Cash <br />AWD 4 Door Utility Vehicle <br />For Change Orders Only <br />Amount of ❑ Increase <br />❑ Decrease��a���,�oF� <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount <br />1m ,p R \lolmr ltunbu — _ <br />I.indn ll. �(;nlin. �IerA <br />