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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />MW <br />Legal <br />Controller <br />Purchasing <br />FEW <br />LA Agreement Amendment <br />Professional Services <br />F-1 Bid Opening <br />[J Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />Mvxbther-, i'VIANk, ;(\­y,) 4,4 <br />Company or Vendor Name <br />Department <br />Division/Bureau <br />Phone Extension <br />Attorney Name: <br />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 />Ll Contract <br />F-1 Resolution <br />[I Bid Award <br />F-1 Quote Award <br />0 C/O & PCA No <br />F-1 Traffic Control: <br />New Vendor <br />MBEANBE Contractor <br />MBEANBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />If,-,' ,M., r, tlhl�, �,"' <br />L1 Ys 0 <br />9= <br />ROOM MIT NI'll, <br />F1 Req. to Advertise F-1 Title Sheet <br />SIM <br />If Yes, Approved by <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Amount of " Increase $ <br />El Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Copy <br />Original <br />F] <br />F1 <br />F-1 <br />El <br />11 <br />E] <br />