HomeMy WebLinkAboutRequest to Advertise - Miami Basin Valve Replacement Project No 116-082DBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date November 4, 2019
Name Roger T. Nawrot
Department Public Works
Division/Bureau Engineering
BPW Date November 11, 2019 Phone Extension 5932
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R�quired Prior to Submittal to Board
Legal ❑] Attorney Name:
Controller Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing El
Check the
[_J Agreement
[l Professional Services
❑ Bid Opening
El Quote Opening
[] Change Order No. _
Ease/Encroach.
Other:
Company or Vendor Name
Y Contract ❑ Proposal
nWT� eyebmissions
[] Resolution
[l Bid Award ® Req. to Advertise
R Quote Award
❑ C/O & PCA No. ❑ PCA
Traffic Control:
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
uired Information
Addendum
® Title Sheet
❑ Yes ® No ❑ If Yes, Approved by
Purchasing
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No 0 Yes Name of Company
Miami Basin Valve Replacement
116-082 D
SewerFund and South Side TIF
226-0419-672.42-03 430-1050-460.42-01 _.�...._�.........___���...w
" Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
equiired For Change Orders Only
Amount of Increase w$w ................ w
❑ Decrease $
Previous Amount $
Current Percent of Change: w %
New Amount $
_. .-..... .........
Total Percent of ange ... _............. ....... ___ %
Dispersal After Accroval
Copy
Original
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