HomeMy WebLinkAboutRequest to Advertise - Ewing Ave & Fellow St Traffic Signal Replacement Proj No 118-097BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date September 30, 2019
Name Roger T. Nawrot
Department Public Works
Division/Bureau Engineering
BPW Date October 8, 2019 Phone Extension 5932
Re uired Prior to Submittal to Board
Legal F-1 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 D
Check the
LJ Agreement
F1 Professional Services
E] Bid Opening
[:] Quote Opening
E] Change Order No.
E] Ease/Encroach.
F-1 Other:
Company or Vendor Name
!Tqp��a , _Le .. I - tem T " ype - Required for All Submissions
El Contract Proposal
OI Resolution
Bid Award Req. to Advertise
E] Quote Award
0 C/O & PCA No. El PCA
F-1 Traffic Control:
New Vendor
MBE/WBE Contractor
MBEIWBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Required Information
Addendum
Z Title Sheet
El Yes Z No E] If Yes, Approved by
Purchasing.
MBE E] WBE
J:1 No 0 Yes.. Name of CqTRan y
,- . . . . ...........
Ewing Avenue and Fellows Street Traffic Signal Replacement
118-097
...........
LRSA Traffic Signal Maintenance
251.0608.431.36-67
L_J Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
..................
. . . ................ . ..... Required For Change Orders
Amount of F-1 increase
El Decrease
Previous Amount $
Current Percent of Change, %
4of Pql6fi, New Amount tsord V
Total Percent of Cha e: %
..............
Disoersal After Atmroval A - OCT (11,111 d-
Copy
Original
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