HomeMy WebLinkAboutRequest to Advertise-Berlin Place Site Development Project No. 116-089Date 10/18/2016
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Department Public Works
Name Richard Estes Division/Bureau Engineering
BPW Date 10/25/2016 Phone Extension 5896
Required Prior to Submittal to Board
Legal ® Attorney Name: Michael Schmidt
Controller ❑ Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing ®
George King
Check the Appropriate Item Type — Required for All Submissions
❑
Agreement
❑ Contract ❑ Proposal ❑ Addendum
❑
Professional Services
❑ Resolution
❑
❑
Bid Opening
Quote Opening
❑ Bid Award ® Req. to Advertise ® Title Sheet
❑ Quote Award
❑
Change Order No.
❑ C/O & PCA No. ❑ PCA
❑
Ease/Encroach.
❑ Traffic Control:
FI
Other:
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
❑ Yes ® No ❑ If Yes, Approved by
J WBE
Yes Name
;e Site DevE
11
324-1050-460.31-02
Work for Site
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Required For Change Orders Only
Amount of ❑ Increase $
❑ Decrease $
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Chanae:
Copy
Original
®
❑ Roger
®
❑ Chris C
®
❑ Patrick
Nawrot