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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />March 19, 2018 <br />Michael Schmidt <br />Purchasing ® Michael Schmidt <br />Department Admin/Finance <br />® Agreement <br />............. <br />❑ Contract <br />❑ Proposal <br />Ll Addendum <br />❑ Professional Services <br />❑ Amendment <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise <br />❑ Title Sheet <br />❑ <br />Quote Opening <br />❑ Quote Award <br />❑ <br />Chg Order No. <br />❑ <br />C/O & PCA No. <br />❑ <br />PCA <br />❑ <br />Ease./Encroach. <br />❑ <br />Traffic Control <br />❑ <br />Resolution <br />❑ Other: <br />❑Claim <br />Re aired information <br />Company or Vendor Name <br />JP Morgan Chase <br />❑ Yes ❑ If Yes, <br />Approved by Purchasing <br />New Vendor <br />❑ <br />No <br />MBEMIBE Contractor <br />❑ <br />❑ <br />MBE Completed <br />WBE <br />E-Verify Form Attached <br />❑ Yes <br />❑ No <br />Project Name <br />User Card Agreement — JP Morgan Purchasing Card Program <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />NIA <br />NIA <br />For :Chan °e.Orders O'nl <br />Amount of ❑ <br />increase <br />$ <br />❑ <br />Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy . Original <br />® ❑ <br />Jen Hockenhull & Michael Schmidt <br />❑ ❑ <br />0 ❑ <br />