HomeMy WebLinkAboutRequest to Advertise - Water Works Utility Service Line Repair ProgramBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 10/30/20
Name Ken Smith Department Utilities
BPW Date 11/10/20 Phone Extension 6108
Review and Approval Required Prior to Submittal to Board
Diversity Compliance
and Inclusion Officer Officer Name
BPW Attorney Attorney Name Clara McDaniels
Dept. Attorney Attorney Name
Purchasing
Check the Appropriate Item Type – Required for All Submissions
Professional Services Agreement Contract Proposal
Open Market Contract Amendment/Addendum Special Purchase, QPA
Bid Opening Bid Award Req. to Advertise Title Sheet
Quote Opening Quote Award Reject Bids/Quotes
Proposal Opening C/O & PCA No. PCA
Chg. Order, No. Traffic Control Resolution
Other: Ease./Encroach
Required Information
Company or Vendor Name
New Vendor Yes If Yes, Approved by Purchasing
No
MBE/WBE Contractor MBE
WBE Completed E-Verify Form Attached Yes
No
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description Request to advertise for applications from vendors to participate in the Water
Works Utility Service Line Repair
Program._______________________________________________________
___________________
For Change Orders Only
Amount of Increase
Decrease
$
($ )
Previous Amount $
Current Percent of Change:
Increase
Decrease
%
( %)
New Amount $
Total Percent of Change:
Increase
Decrease
%
( %)
Time Extension Amount:
New Completion Date: