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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01 /09/2019 <br />Name Amv Shirk <br />Purchasing ❑ <br />Check the A <br />H Agreement <br />Professional Services <br />Bid Opening <br />Quote Opening <br />❑ Chg Order No. <br />❑ Ease./Encroach. <br />C Other: Disoosal <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 />Item Troe — <br />LJ Contract <br />n Amendment <br />El Bid Award <br />❑ Quote Award <br />❑ C/O &PCANo, <br />❑ Traffic Control <br />Department Admin & Finance <br />for All Submissions <br />Proposal R Addendum <br />0 Req. to Advertise ❑ Title Sheet <br />red Information <br />t�Up <br />Resolution 6hu <br />Iq <br />Claim <br />_Www ... _.._. ........ <br />Yes If Yes, Approved by Purchasing <br />❑ No <br />WBECompleted E-Verify Form Attached NoEl <br />For Change Orders Qrtj. <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 />❑ <br />El <br />