HomeMy WebLinkAboutRequest to Advertise - Berlin Place #2 MEPDate
Name
3/6/17
Corbitt Kerr
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Department
Division/Bureau
Public Works
Engineering
BPW Date 3/14/17 Phone Extension 5931
Re uired 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
❑ Bid Award ® Req. to Advertise ® Title Sheet
❑ Quote Opening
❑ Quote Award
❑ Change Order No.
❑ C/O & PCA No. ❑ PCA
❑ Ease/Encroach.
❑ Traffic Control:
❑ 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
!red I
❑ Yes ❑ No ❑ If Yes Approved by Purchasing
❑ MBE ❑ WBE
❑ No ❑ Yes Name of Com any
Berlin Place BP#2: MEP
117-048
RWDA TIF
324-1050-460-3102
Berlin Place MEP Improvements
Advertise 3124 and 3/31
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
I Required For Chance Orders Onlv I
Amount of
Increase
Decrease
Previous Amount $ errauvf`ry
Current Percent of Change: % is or
New Amount
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