HomeMy WebLinkAboutRequest to Advertise - Colfax Avenue Two-Way ConversionBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW RE,UEST FORM
Date March 19, 2018
Department Public Works
Name Roger Nawrot Division/Bureau Engineering
BPW Date April 24, 2018 Phone Extension 5932
Required Prior to Submittal to Board
Legal Z Attorney Name: Clara McDaniels
Controller z 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 z
F_ Check the Appropriate Item Type - Required for All Submissions
F-1 Agreement F] Contract Ll Proposal El Addendum
F-1 Professional Services F-1 Resolution
F1 Bid Opening El Bid Award ❑ Req. to Advertise ❑ Title Sheet
F-1 Quote Opening 0 Quote Award
❑ Change Order No. F-1 C/O & PCA No. ❑ PCA
❑ Ease/Encroach. ❑ Traffic Control:
F-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
uired Information
El Yes E] No E:1 If Yes, Approved by
Purchasing
El MBE F-1 WBE
F-1 No 0 Yes Name of Company
Colfax Avenue Two -Way Conversion
-
115-05 3A
West Washington Develo meat Area TIF
422. 1 a5o.460.a2.
$
Not to Exceed ff
H Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, IE-Verify, Iran, etc.)
Amount of H Increase $
El Decrease $
Previous Amount $
Current Percent of Change: % V&D
New Amount works
Total Percent of Change. % MAR 2 7 m
Dispersal After Approval 'Ie � *'7_'71
Copy Original
E F❑I Chris Dressel
❑ El
El El