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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/22/2019 _ Department Public Works <br />Name To Villa Division/Bureau Engineering <br />ineering <br />.......... ...................... ��..._ <br />BPW Date 052/28/2019 Phone Extension 5920 <br />MmmWrYm, ....[mmn eeNHbNJ „YrAM+�+iL�s"JiLSm4WiH6nNNIGMYWAdW��W�oIVW�u�u��eNWi�iriPM1!5 mr�m,�v�rmvs�,.?*ppmIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIImiIIM tlk'�IIMMi�V�WINNmmIM1'W'4'iMV iNIFr� : w rtmmtlulN. � P..�W,W,W,W�W�"YRI�I�W •.. .., 5Ym IWINnmmmmmmmmm�P5i�R11�=H <br />.......... _ ....�, ,.,.......___..w ..... _.�,�.�._........ <br />eared Prior toSubmittalto Board <br />Legal [� AttorneyName: TT.��. �--m.�..._... m...�.�.,,,,..., ......__. <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 />L9 Agreement <br />❑ Professional Services <br />[] Bid Opening <br />❑ Quote Opening <br />® Change Order No. 3 <br />Ease/Encroach. <br />Other: <br />�r priate Item Type — <br />E Contract <br />R Resolution <br />❑ Bid Award <br />❑ Quote Award <br />C/O & PCA No. — <br />❑] Traffic Control: <br />Company or Vendor Name <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 />Copy <br />Original <br />E <br />1:1 <br />D <br />for All Submissions <br />Proposal <br />❑ Req. to Advertise <br />ired Information <br />❑ PCA <br />CBS Services, LLC <br />Yes [❑ No ❑ If Yes, Approved by Purch asi <br />30 Day Time Extension <br />Dispersal After Approval <br />Addendum <br />❑ Title Sheet <br />