HomeMy WebLinkAboutRequest to Advertise - Chet Waggoner CourtDate
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
7/19/2016
Public Works
Engineering
BPW Date 7/26/2016 Phone Extension 5896
Richard Estes
Department
Division/Bureau
I
Required Prior to Submittal to Board
Legal ®
Attorney Name: Michael Schmidt
Controller El
review is required for all Contracts $5,000.00 or more and
greater
greater than one year in length per the City Purchasing Policy
Purchasing ®
George King
Check the Appropriate Item Type - Required for All Submissions
❑
Agreement
❑ Contract ❑ Proposal ❑ Addendum
❑
Professional Services
❑ Resolution
❑
Bid Opening
❑ Bid Award ® Req. to Advertise ® Title Sheet
❑
Quote Opening
❑ Quote Award
❑
Change Order No.
❑ C/O & PCA No. ❑ PCA
❑
Ease/Encroach.
❑ Traffic Control:
❑
Other:
Required Information
Company or Vendor Name
New Vendor
MBE/WBE Contractor
MBE/WBE Contractor Requested
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
❑ Yes ❑ No ❑ If Yes, Approved by
❑ MBE ❑ WBE
_❑ No ❑ Yes Name of Company
Chet Waggoner Court
116-005
RWDA TIF
324-1050-460.31-02
Request Bids for new road off of Dylan Drive between Brick and
Adams. Bids Due 8/18, Bid Award 8/23
❑ Required Contractor's Certification Forms Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
uired For Chanqe Orders
Amount of II Increase $
El Decrease $
Previous Amount $ °o+d of
Current Percent of Change:
New Amount $
Total Percent of Chance: % -S� J L Z
a
Copy
Original
®
❑