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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/29/16 <br />Department Adm/Finance & Public <br />Name John Murphy/Eric Horvath Works <br />BPW Date 11/8/16 w r'\ <br />Phone Extension 7678 <br />Re wired Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ® George King <br />Check the Appropriate Item Type — Required forAii Submissions <br />® Agreement ® Contract ❑ Proposal ❑ Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award <br />Opening ❑ Req. to Advertise ❑Title Sheet <br />❑ Quote O <br />P g ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />❑ Other: <br />Required Information <br />Company or <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of <br />Umbaugh <br />Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE F-1 WBE <br />2016 Waterworks Bond Refunding Financial Advisor <br />None <br />2016 Waterworks Bond Refunding Proceeds <br />None. Will be paid at closing from bond proceeds. <br />$ 35,500.00 - Articles No. I to IV <br />Municipal Advisory Services with respect to the 2016 Waterworks Bond <br />Refunding. Fees set forth in Exhibit B. Articles No. I, II, III, and IV. <br />Excludes Articles No. V and VI. <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination. Nan-DPharmPnt PA/Prifv Iran atr <br />Increase <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 />Change Orders <br />"/o <br />Dispersal After Approval <br />