Laserfiche WebLink
BOARD OF PUBLIC WORKS <br /> AGENDA ITEM REVIEW REQUEST FORM <br /> Date July 16, 2015 <br /> Name Carl Littrell Department PW/ Engineering <br /> BPW Date July 28, 2015 y yPhyone Extension 5937 <br /> 1;-, r e.,,,Yfi3 9r4R` .. �` c*a.' -0 -0 i" 0�..�j•14.J:a a L l4'( l�lSJTIr= 0 . Y. pn 1'n <br /> Legal X Attorney Name Ben Daugherty <br /> Controller X Controller review is required for all Contracts $5,000.00 or more and <br /> greater than one year in length per the City Purchasing Policy <br /> Purchasing X <br /> {, eta .. » _47?c <br /> a.:° ��C 'es <, o Drop la�l e . .��" CI:�l�1D� om� 0 5' _� �72, <br /> • Agreement • Contract Proposal • Addendum <br /> ❑ Professional Services ❑ Resolution <br /> ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br /> ❑ Quote Opening ❑ Quote Award <br /> ❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br /> ❑ Ease/Encroach. ❑ Traffic Control <br /> ❑ Other: Vacation <br /> s_ <br /> _;7 r t7 `frj @G . w _,�p? ' 77cW_ m <br /> Company or Vendor Name <br /> New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br /> MBE/WBE Contractor ❑ MBE ❑ WBE <br /> MBE/WBE Contractor <br /> Requested ❑ No ❑ Yes Name of Company <br /> Project Name Main/Lafayette Connector <br /> Project Number 110-058 <br /> Funding Source <br /> Account No. <br /> Amount <br /> Terms of Contract <br /> Purpose/Description <br /> Li Required Contractor's Certification Form Attached(Non- <br /> Collusion, Non-Discrimination, Non-Debarment, E-Ver' , Iran, etc. <br /> Amount of ❑ Increase $ <br /> ❑ Decrease $ <br /> Previous Amount $ <br /> Current Percent of Change: <br /> New Amount $ <br /> Total Percent of Change: <br /> Copy Original <br /> X ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br />