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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />09/27/20,18 <br />Department <br />Public Works <br />Name <br />Toy Villa <br />Division/Bureau <br />Engineering <br />BPW Date <br />10/9/201'8 <br />. .......... . .. . ..... <br />Phone Extension <br />5920 <br />Required Prior to Submittal to Board <br />Legal El Attorney Name: <br />Controller El 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 El <br />H Agreement Amendment <br />H Contract LJ Proposal Ll Addendum <br />F] Professional Services <br />El Resolution <br />0I Bid Opening <br />El Bid Award El Req. to Advertise El Title Sheet <br />F-1 Quote Opening <br />F-1 Quote Award <br />F-1 Change Order No. <br />F C/O & PCA No. PCA <br />F-1 Ease/Encroach. <br />F Traffic Control: <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />MIIMRMSEZ�� <br />Walsh & Kelly, Inc. <br />0 Yes M No ❑ If Yes, Approved by <br />Purchasing <br />[:] MBE [:] WBE <br />El No 01 Yes Name of Company <br />Cei6hton Parking Garage Entrance Repair <br />118-038 <br />Major Moves <br />412-0401-415,36-01 <br />Project Closeout <br />E] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />Required For Change Orders Only <br />Amount of F-1 increase $ <br />[:1 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 />F1 <br />R <br />F1 <br />F1 <br />El <br />1:1 <br />