Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />5-01-2019 <br />Department <br />Name Bradlev J. VanOosterum <br />Utilities- Water <br />Treatment <br />BPW Date 5-14-2019 Phone Extension 5670 <br />mod➢ @NWN�NW.A4' �wx �;�,ryryryry�i�i�� r—k'Nf�%I�v11vF^JAfIWM�WRl9lflr�i q�P��✓+=��'�'��'�++',, 1 lip',M1IMdIIdIIIVIVIVIVIVIWWWL'WWII YAIW/N IVV'N.g14W �WWy�WWWy��yWH�NVfV' '„� q� <br />a Required Prior to Submittal to Board <br />......._ <br />Legal ® Attorney Name Clara McDaniels <br />Controller ® 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 <br />Check the <br />L-.J Agreement <br />[ Professional Services <br />❑ Bid Opening <br />E:1 Quote Opening <br />Change Order No. <br />Ease/Encroach. <br />Other: <br />Company or Vendor Name <br />MultipleVendors <br />Topriate Item Type — Required forAllSubmissions <br />❑ Contract ❑ Proposal <br />El Resolution <br />® Bid Award El Req. to Advertise <br />❑ Quote Award <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control <br />Required Information <br />New Vendor ❑ Yes Z No M If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE [] WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Water Treatment Chemicals 2019-2020 <br />Project Number <br />Funding Source <br />..... n <br />Account Various udaets <br />Amount No $Unit Bid Pricing onal B <br />Addendum <br />❑ Title Sheet <br />Terms of Contract 1 YEAR <br />Purpose/Description Chemical Bid unee ded to secure com etitive mm..riciu......._.. <br />Required Contractor's Certification Form Attached (Non - <br />Collusion, NonDiscrimination, Non Debarment, E-Verilrar, etc. _. __-- <br />_u o. dared For Chanrders Only <br />....... <br />Amount of ❑ Increase $wm_-�.�..�._... _...........�.�.�.. <br />[:' Decrease $ <br />Previous Amount $ ...w <br />Current Percent of Change: /o <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Appr oval <br />Copy Original <br />® ❑ Michael Schmidt <br />® ❑ Bradley J. Van Oosterum <br />