HomeMy WebLinkAboutRequest to Advertise - Ductile Iron Pipe, Gate Valves & Fire HydrantsBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date February 20, 2017
Name Bob Krol Department Utilities- Water
BPW Date February 28, 2017 Phone Extension 5660
Required Prior to Submittal to Board
Legal x Attorney Name Michael Schmidt
Controller x 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 x
unecK the Appropriate Item I ype — Kequired for All Submissions
Agreement ❑ Contract ❑ Proposal ❑ Addendum
❑ Professional Services ❑ Resolution
❑ Bid Opening ❑ Bid Award x Req. to Advertise ❑ Title Sheet
❑ Quote Opening ❑ Quote Award
❑ Change Order No. ❑ C/O & PCA No. ❑ PCA
❑ Ease/Encroach. ❑ Traffic Control
❑ Other:
Required Information
Company or Vendor Name
New Vendor
❑ Yes x No ❑ If Yes, Approved by Purchasing
MBE/WBE Contractor
❑ MBE ❑
WBE
MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company
Project Name
Ductile Iron Pipe, Gate Valves, & Fire Hydrants
Project Number
Funding Source
Water Works Operating Fund and Capital Fund
Account No.
620-0640-606.23-62 and 620-0640-661.46-04
Amount
660—'
Terms of Contract
One year from date of award with option for one year extension
Purpose/Description
Bid material purchase of various sizes of pipe valves hydrants
Amount of
Increa
Decree
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Change:
Copy Original
❑ x
x ❑
x ❑
Roxanne
Kim Thor
Bob Krol
x Required Contractor's Certification Form Attached (Non -Collusion,
Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.
.Required For Chanae Orders Onlv