Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/08/2019 Department Public Works <br />Name Toy Villa ��...........................................�......� �_�...�. Division/Bureau �.E���.�����_................m�. .......�..�................ <br />ng' eering <br />........ .....w.. m__.._,� _.. ..... <br />BPW Date 01/22/2019 Phone Extension 5920 <br />u�m mmmmmmwu �.m^.mr i... mnmmuwru�zmna mmmuuuwmmmmmi mmrmeu mw. w mmmuummmmmmuuuummiwmuuuuuuummmu uuummmMm Immm <br />..._. Re wired Prior to . <br />Submittal to Board <br />Legal Attorney Name: <br />Controller F] 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 />Check the <br />H Agreement <br />El Professional Services <br />Bid Opening <br />D Quote Opening <br />❑ Change Order No. <br />❑Ease/Encroach. <br />F-1 Other: <br />Company or Vendor Name <br />prop riate Item Ty Required for All Submissions <br />Contract Proposal <br />Resolution <br />❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Award <br />El C/O & PCA No. ® PCA <br />❑ Traffic Control: <br />New Vendor <br />MBE/WBE 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 />Amount of LJ Increase <br />[—] Decrease <br />Previous Amount $ <br />................ <br />Current Percent of Change: % <br />New Amount $.... <br />Total Percent of Change: % <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Required Information <br />Walsh &,Kell , Inc. <br />Proiect Closeout <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />.W <br />.w yired For Charm Orders n!y..............._. <br />.......--------------------- <br />...�� m,,,,,.�.�..................����.. <br />Dispersal After Aooroval <br />