HomeMy WebLinkAboutRequest to Advertise - Ravina Park Bank Stabilization Project No 117-073ADate
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
0 1 001IM1 U-6
Alicia Czarnecki
Department
Division/Bureau
Public Works
Engineering
BPW Date 06/12/2018 Phone Extension 5903
. . . .... ...
Required Prior to Submittal to Board
Legal El Attorney Name: Clara McDaniels
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
Check the Appropriate Item Type — Required for AH Submissions
El Agreement Amendment P Contract El Proposal F1 Addendum
F-1 Professional Services El Resolution
❑I Bid Opening El Bid Award M Req. to Advertise E:1 Title Sheet
F-1 Quote Opening F-1 Quote Award
❑ Change Order No. F] C/O & PCA No.. ❑ PCA
Ease/Encroach. ❑ Traffic Control:
❑ Other: General Release Required Information
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBEAA1BE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
TBD
El Yes E] No F-1 If Yes, Approved by
Purchasing
[:] MBE [:] WBE
n No El Yes Name of Company
Ravina Park — Bank Stabilization
11 7-073A
El Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Amount of 0 increase $ A fl-"W(ND
F-1 Decrease
Previous Amount $
Current Percent of Change
New Amount
Total Percent of Change:
% bmw 1: -
Dispersal After Approval
Copy
Original
M
F-1 Kara Boyles, City Engineer
E
E] Alicia Czarnecki
F
El