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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />7/14/2016 <br />Engineering <br />Public Works <br />BPW Date 7/26/2016 Phone Extension 5998 <br />Blair Bennett <br />Department <br />Division/Bureau <br />I <br />Required Prior to Submittal to Board <br />Legal ® <br />Attorney Name: <br />Controller ❑ <br />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 <br />❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />Agreement ❑ Contract <br />❑ <br />Professional Services <br />❑Pro osal <br />❑ Resolution p ❑Addendum <br />❑ <br />❑ <br />Bid Opening <br />Quote Opening <br />❑ Bid Award <br />El Quote Award ❑ Req. to Advertise ❑Title Sheet <br />® <br />Change Order No. 2 <br />❑ C/O & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ Traffic Control: <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ® Increase <br />❑ Decrease <br />Previous Amount $ 1 <br />Current Percent of Change: 1.4 <br />New Amount $ 1 <br />Total Percent of Change: 19. <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />0 <br />❑ <br />JJamco Construction, Inc. <br />❑ Yes ❑ No <br />Purchasin <br />❑ MBE WBE <br />❑ No ❑Yes Name of C <br />Hoffman Hotel Renovatior <br />115-071 <br />River West TIF <br />$170,899.37 <br />If Yes, Approved by <br />vvindow Replacement to Hoffman Hotel <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />squired For Chanae Orders Only <br />37 <br />