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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /1w5/2018.......... <br />Name Arnim/ Shirk Department Admin & Finance <br />BPW Date 11/27/2018 Phone Extension 9133 <br />Required Prior to Submittal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing <br />Check the p <br />LJ Agreement <br />Professional Services <br />❑ Bid Opening <br />El Quote Opening <br />Chg Order No. <br />Ease./Encroach. <br />Other: I iswsal <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 />Purpose/Description <br />pro r!ate LtgTLType - <br />El Contract <br />D Amendment <br />0 Bid Award <br />El Quote Award <br />[� C/O & PCA No. <br />[� Traffic Control <br />for All Submissions <br />Proposal _ F] Addendum <br />❑ Req. to Advertise <br />PCA <br />esolution <br />Claim <br />uired Information <br />❑ Title Sheet <br />µ El Yes El If Yes, Approved by Purchasing <br />❑ No <br />MBE Completed E-Verify Form Attached El Yes <br />WBE ❑ No <br />For Chaniae Orders Only. <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 />EJ <br />El <br />EJ <br />El <br />0 <br />