HomeMy WebLinkAboutRight of Way Dedication - Portage Avenue at Boland Drive RoundaboutBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date August 15, 2019
Department Public Works
Name RogerT. Nawrot
Division/Bureau Engineering
BPW Date August 26, 2019
Phone Extension 5932
Required Pdorto Submittal to Board
Legal ®
Attomey Name:
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 ❑
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 & PGA No. _ ❑ PCA
❑
Ease/Encroach.
❑ Traffic Control:
❑
Other: Right of Way Dedication
_R"aired Information
Company or Vendor Name
❑ Yes ❑ No ❑ If Yes, Approved by
New Vendor
Purchasing
MBEWBE Contractor
❑ MBE ❑ WBE
MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company
Project Name
Portage Avenue at Boland Drive Roundabout
Project Number
118-065
Funding Source
Account No.
Amount
Terms of Contract
- ......................................... -- -----------...-........-
Purpose/Description
Right of Way dedication of City owned land.
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
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Amount of ❑ Increase $ _. ............................. .. _
❑ Decrease $
Previous Amount
$..............__...
—..............
Current Percent of Change:
J
New Amount
$ - ................_.....--
Total Percent of Change :........................................
_._._._...... -
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Dispersal After Approva.l....._...............
Copy Original
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