Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/05/19 <br />Name Alicia Czarnecki/Tod Villa Department En meerin <br />BPW Date 06/11/19 <br />Phone Extension 5903 <br />Required Prior to Submittal to Board � <br />Legal <br />Attorney Name <br />Controller EiController 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 />uheck the <br />LJ Agreement <br />E Professional Services <br />Bid Opening <br />❑ Quote Opening <br />® Change Order No. 5 <br />El Ease/Encroach. <br />Other: <br />rro riate Item T p / "e <br />❑ Contract <br />E Resolution <br />❑ Bid Award <br />❑ Quote Award <br />C/O & PCA No, <br />Traffic Control <br />for All Submissions rProposal ❑�! Add—en dum_ <br />0 Req. to Advertise ❑ Title Sheet <br />❑ PCA <br />q uired Information <br />....._ <br />Company or Vendor Name The Robert HenryCorporation <br />New Vendor ❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name _..1 18 Main046Rtenance Storage Building <br />Project Number �mmm WwwW <br />Funding Source Park Bond Seerie......s rie......_...... <br />I <br />Account No. 471-1138-452.42-01 <br />Amount $ <br />Terms of Contract <br />Purpose/Description Approval of C.O. #4 <br />Amount of <br />El <br />❑ Required Contractor's Certification Form Attached (Non- <br />Collusion, Non-Discrimination, Non -Debarment, E-Verif�v, Iran, etc. <br />Re uired For q .Orders Oril <br />Increase $ <br />Decrease �... ....,,, <br />$ 396.00 <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Copy <br />Original <br />® <br />F] Toy Villa <br />