Laserfiche WebLink
OFFICE OF THE CONTROLLER AND <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Department <br />BPW Date Phone <br />Name <br />o � Legal ❑ Attorney Name: <br />a � -o Controller ❑ ControlIer review is required for all Contracts $5,000.00 or more and greater than one <br />E 3 -. year in length per the City Purchasing Policy <br />Q3 o OTHER <br />CQ <br />0 APPROPRIATE <br />°' o o ❑ REVIEWERSOther, as appropriate: <br />Type of Item ❑Contract/Agreement ❑Proposal ❑Addendum ❑Claim <br />®Easement/Encroachment ❑Resolution ❑Traffic Control Device <br />❑ Other: <br />- - - ---------------------------------------------------------------------------------------- <br />U Company or Vendor Name Danch Harner & Associates <br />Project Name _ Easements for public sewer along SR 23 <br />6b 8 •� Project Number (Engineering) Proj. Code (Controller) <br />¢ o Gd Amount <br />Purpose/Description: <br />U i cn <br />Cd O <br />0 <br />0 <br />U Q Terms of Contract: <br />Effective Date <br />a� <br />O <br />n <br />Ar <br />$ Funding Source <br />Dedication of public easements for sanitary sewer along rear lot lines, the <br />first along the Breadsmith property and the second along the old Coach's Bar <br />property_ Easements have been recorded. �O ct ( sib <br />------------------------------------------------------------------------------------------- <br />End Date <br />Type of Item ❑Advertise ❑Bid Opening ❑Bid Award ❑Amendment ❑Title Sheet <br />----------------- <br />Company Name <br />Project Name <br />Project Number (Engineering) <br />Contract/Project Amount <br />Type of Item ❑Ch_g Order <br />Contractor/Consultant Name <br />Project Name <br />Project Number (Engineering) <br />PO Number <br />Amount of ❑Increase ❑Decrease <br />Original Contract/Project Amount <br />New Contract/Project Amount <br />Purpose/Description: <br />Coov Original <br />i✓ > <br />a� O ❑ <br />� O Cl. <br />H <br />Proj. Code (Controller) <br />Funding Source <br />❑C/O & PCA_ ❑PCA_ ❑Other:----------------------------------- <br />Proj. Code (Controller) <br />Funding Source <br />Total Percent of Change: <br />List Name, Dept., Address (if appropriate) of who should receive document <br />