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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/20/2017 <br />Name <br />Kieran Fahey <br />Department <br />LTCP <br />BPW Date <br />03/2812017 <br />Phone Extension <br />5993 <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 ❑ <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. _ <br />Ease/Encroach. <br />Other: <br />Contract ❑ Proposal ❑ Addendum <br />Resolution <br />Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />Quote Award <br />C/O & PCA No. ❑ PCA <br />Traffic Control <br />Company or Vendor Name: Black and Veatch Corporation <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEMBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ® No ❑ Yes Name of Company <br />Project Name LTCP relook Peer review <br />Project Number 117-045 <br />Funding Source Wastewater <br />Account No. 641-0630-793-31-02 <br />Amount $ 74,965 <br />Terms of Contract To peer review LTCP relook data/models, findings, etc <br />Purpose/Description ❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of ❑ Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />