Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 08/19/16 <br />Name Toy Villa Department Engineering <br />BPW Date 09/13/16 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />Legal ❑ Attorney Name <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate Item Type — Required for All Submissions <br />❑ Agreement ❑ Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ® PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor <br />Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Required Informa <br />and Bros., Inc. <br />No ❑ If <br />E❑WBE <br />❑ No LJ Yes Name of Company <br />Demolition of Vacant & Abandoned Houses — Division D <br />115-128 <br />COIT <br />404.1201.415.39.87 <br />$ 94,926.00 <br />Project Closeout <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination _ Nnn-r)Pharmanf F-\/arifv Iran ate <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />❑ <br />® <br />❑ <br />® <br />❑ <br />For Change Orders <br />Dispersal After Approval <br />Elizabeth Maradik, Beth Leonard, Judy Love <br />IVIIKe uar <br />Tov Villa <br />