HomeMy WebLinkAboutRequest to Advertise - Two-Way Conversion of Colfax Ave Phase II Project No 115-053BBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date
Name
10/15/19
Kvle Silveus
Department En ineerin
BPW Date 10/22/19 Phone Extension 9083
Re hired Prior to Submittal to Board -
Legal ❑ Attorney Name Clara McDaniels
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
Che,
" Agreement
El Professional Services
Bid Opening
❑ Quote Opening
F-1 Change Order No.
El Ease/Encroach.
F� Other:
❑ Michael Schmidt
L....l Contract
❑]I Resolution
❑ Bid Award
❑' Quote Award
�C/O &PCANo,
Traffic Control
4 for All Submissions
El Proposal El Addendum
® Req. to Advertise „Title Sheet
❑ PCA
Company or Vendor Name N/A
New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing
MBE/WBE Contractor ❑ MBE FIWBE
MBE/WBE Contractor Requested ❑ No n Yes Name of Company
Project Name mmTwo-Way Conversion of Colfax Ave. — Phase II
Project Number 115-053B
Funding Source West Washington Development Area TIF
Account No. 422-1050-460-42-03
Amount $ N/A
Terms of Contract
Purpose/Description ❑ Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
,
Amount of ❑ Increase
Decrease $
Previous Amount $
VIE a
Current Percent of Change: % P
New Amount ... W.
Total Percent of Chan
Copy
Original
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