HomeMy WebLinkAboutRequest to Advertise - 2017 Street and Sewer Dept. MaterialsDate
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
February 21, 2017
Tara Weigand
Department Public Works
Division/Bureau Engineering
BPW Date February 28, 2017 Phone Extension 5998
Required Prior to Submittal to Board
Legal ® Attorney Name: Michael Schmidt
Controller El greater
review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing
Check the Appropriate Item Type — Required for All Submissions
❑ Agreement Amendment
❑ Contract ❑ Proposal ❑ Addendum
❑ Professional Services
❑ Resolution
❑ Bid Opening
❑ Bid Award ® Req. to Advertise ❑ Title Sheet
❑ Quote Opening
❑ Quote Award
❑ Change Order No.
❑ C/O & PCA No. ❑ PCA
❑ Ease/Encroach.
❑ Traffic Control:
I-1 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
Amount of
Increase
Decrease
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Chanoe:
Copy
Original
®
❑ Kara Boyle
®
❑ Roger Nau
®
❑ Terri Swift
red Information
202-0619-431.23-03, .23-21, .23-24
640-0620-811.22-24, .23-24
641-0621-792.22-24, .23-02, .23-03, .23-04
641-0625-792.22-24, .23-04
Unit Price
Purchase of materials for Street and Sewer Departments
LJ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
For Chance Orders On
I After Approval