HomeMy WebLinkAboutRequest to Advertise - Fire Station No. 9 Project No 116-002Date
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW RE' QUEST FORM
January 16, 2018
Tara Weigand
Department
Division/Bureau
01-011=71iffin
Engineering
BPW Date January 23, 201'8 Phone Extension 5998
Required Prior to Submittal to Board
Legal EJ Attorney Name-,
Controller El 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 1:1
LJ
Agreement Amendment
Contract 0 Proposal 0 Addendum
F�
Professional Services
❑
Resolution
F-1 Bid Opening
El
Bid Award Z Req. to Advertise M Title Sheet
F1 Quote Opening
F-1
Quote Award
F-1 Change Order No.
R C/O & PCA No., ❑ PCA
Ease/Encroach,
F] Traffic Control:
Other:
Company or Vendor Name
New Vendor
MBEANBE Contractor
MBEANBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
El Yes [:] No F] If Yes, Approved by
Purchasina
L11 MBE LJ WBE
F-1 No F-1 Yes Name of ComDanv
Fire Station #9
Advertise dates 2/2/18, 2/9/18
F� Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Amount of F1 increase $ Al'i"RovsD
❑ Decrease $
Previous Amount $
Current Percent of Change: % JAN 2 3 01 j
New Amount $
Total Percent of Change: %
Dispersal After Approval
Copy Original
M F] Steve Cox
H El Todd Skwarcan . .... .
F-1 EPOCH (Andrew Avara)