Laserfiche WebLink
Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />1/16/201 8 <br />Lauren Trapp <br />Department Utilities <br />BPW Date 1/23/2018 Phone Extension 5852 <br />fie aired Prior t+� Submittal i:o Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000-00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Poky <br />Purchasing ❑ <br />H Agreement <br />0I Professional Services <br />F] Bid Opening <br />n Quote Opening <br />EJ Chg Order No. <br />[:] Ease./Encroach. <br />Z Other: Industrial <br />Discharge Permit <br />Transfer from Noble <br />Americas South Bend <br />Ethanol to, Mercuria <br />Investments Inc. <br />Company or Vendor Name <br />New Vendor <br />MBEANBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />LJ Contract <br />R Amendment <br />F] Bid Award <br />[J Quote Award <br />C/O & PCA No <br />❑ Traffic Control <br />Z= <br />E] Req. to Advertise <br />n PCA <br />El Resolution <br />El Claim <br />El Title Sheet <br />❑ Yes LJ If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />F-1 WBE E] No <br />For Change Orders 04E������� <br />I ncrease $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />El E] <br />