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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11-21-18 <br />Name Al Greek Department Utilities <br />BPW Date 11-27-18 Phone Extension 4210 <br />Required Prior to Submittal to Board <br />Legal x Attorney Name <br />x Controller review is required for all Contracts $5,000.00 or more <br />Controller E:] and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing x <br />f- <br />Check the A <br />LJ Agreement <br />xE1 Professional Services <br />F-1 Bid Opening <br />F-1 Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />New Vendor <br />MBE[WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />tropriate Item Type - <br />El Contract <br />� Amendment <br />for All Submissions <br />...... . ..... . <br />Proposal <br />F-1 Bid Award ❑ Req. to Advertise <br />F-1 Quote Award <br />n C/O & PCA No. ❑ PCA <br />El Traffic Control ❑ Resolution <br />El Claim <br />Reau:ired Information <br />Addendum <br />El Title Sheet <br />Arcadis <br />..... ... .... .... . <br />Yes F-1 If Yes, Approved by Pu rc ha s i n g <br />xF] No <br />F][-] WBE �F] Nos <br />MBECompleted E-Verify Form Attached El <br />Utility Billing System Implementation., ................... . <br />Contractural Services Other (50% water 50% wastewater <br />641-0630-793-6335 <br />�4-10,211 0 <br />... ............ 14 months --- <br />620-0640-657-3135 <br />Purpose/Description Provide Project management for the Utility Billing, System <br />Implementation <br />For Change Orders O.n.!y, ..... ... . ... ........ . 7-1. . ... ....... <br />Amount of ❑ increase <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 <br />Original <br />El <br />F] <br />F-1 <br />R <br />El <br />R <br />