HomeMy WebLinkAboutRequest to Advertise - Wayne St and Leighton Plaza Parking Structure Repairs 2019 Project No 119-048BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name
June 17, 2019
Roqer Nawrot
Department Public Works
BPW Date June 25,2019 Phone Extension 5932
rm .�,wm;auun wwayssrw,w,wam MMMMmmmm ice.... 000000mmMuu I -WOM
_..........._....__. ReNrd Prior to Submittal to ��_..._
Board
Legal F-1 Attorney Name
Controller Controller review is required for all Contracts $5,000.00 or more anc
greater than one year in length per the City Purchasing Policy
Purchasing ❑
Check the
I I Agreement
❑ Professional Services
❑ Bid Opening
❑ Quote Opening
❑ Change Order No. _
❑] Ease/Encroach.
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
um no r1mi
rro riate Item Te -
�] Contract
Resolution
El Bid Award
D Quote Award
❑ C/O & PCA No.
❑ Traffic Control
for All mSubmissions
p Addmen_
Pro osal dum
® Req. to Advertise ® Title Sheet
Required Information
Yes LJ No
MBE .. .......................—
WBE
❑ PCA
If Yes, Approved by Purchasi
0 No ❑ YesNameof Company
-Wayne Street & Leighton Plaza Parkin
�Way „ g m e ,mac Structures Repairs 2019
119-048
Parking Garage Fundmm .
Wayne-601 0464-645 36 01 Leighton 601-0462mm645.36-01
❑ Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Nora -Debarment, E- Verify, Iran, etc.
El increase n
R Decrease $
Previous Amount
Current Percent of Change:
New Amount
Total Percent of Change:
Copy
Original
❑
❑
%
Dispersal After p Approva