HomeMy WebLinkAboutRequest to Advertise - One (1) or More, 2021 or Newer, Track Driven Trommel Screen - Spec EBOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date August 23, 2021
Name Jeff Hudak
Department Central
Services
BPW Date September 14, 2021 Phone Extension
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 Michael Schmidt
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 Organic Resources - Cash
Account No. 642-06-605-515-445000
Amount
Terms of Contract
Purpose/Description _Spec E – One (1) or More 2021 or Newer Track Driven Trommel Screen
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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: