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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date July 12. 2016 <br />Department Community <br />Name Beth Leonard Inks Investment <br />BPW Date June 19, 2016 Phone Extension 9330 <br />I Required Prior to Submittal to Board <br />Legal x❑ Attorney Name Ben Dougherty: Michael Schmidt <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />x❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Kequired Intormation <br />Company or Vendor Name Weidner and Company PC. <br />New Vendor <br />x ❑ Yes [ <br />MBE/WBE Contractor <br />❑ MBE [ <br />MBE/WBE Contractor Requested ❑ No <br />Project Name <br />Not -for - <br />Project Number <br />N/A <br />Funding Source <br />DCI Adr <br />Account No. <br />211-10C <br />Amount <br />$ 65/hot <br />Terms of Contract <br />7/1/16 tl <br />Purpose/Description <br />To hand <br />No x❑ If Yes, Approved by Purchasing <br />WBE <br />Yes Name of Company <br />fit Accounting <br />1-460-31.06 <br />12/31/16 <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Chanae Orders Only <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />