Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />09/19/2019 <br />Maricela Juarez <br />Department Admin & Finance <br />BPW Date 10/08/2019 Phone Extension 9953 <br />YI'�IiVIIIW'WIW'WIWWN'NWIIIIINININIIIIIIIIIIIIIIIIIII'WIVIVWIWL ...nar n gq� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIAWY�;VfAtAP`�m.�sma �„�y,S�IPIIflIIflIIIIIIImPIIMIMIMIMIMIM �?�%iTrTlu7H1AR�i,'. ,MMra---m�]N.�y�QpJQpi,�µ�OGM' fl�WflL4it vsvmmw nowiiq�p�ryyNFY.4!M1DNlkJd. <br />Re uired Prior to Submittal _.. ... <br />__ ITITIT__ITITITwww_ 'ttal to Board <br />Legal Attorney Name <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ❑ and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing [� <br />Check the P <br />II Agreement <br />El Professional Services <br />[j Bid Opening <br />El Quote Opening <br />❑ Chg Order No. <br />❑ Ease./Encroach. <br />F>7\' Other: Di Dos,al <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 />pro riate Item Tie mm <br />El Contract <br />El Amendment <br />El Bid Award <br />El Quote Award <br />[� C/O & PCA No. <br />El Traffic Control <br />for All Submissions <br />Proposal ( Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />PCA <br />esolution6Z AQ" <br />a <br />laim <br />uired Information <br />�.... D.m......nn.- .. w......__m ...mm. � <br />El Yes If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE No <br />For Chaves Orders On <br />Amount of ❑I Increase $ <br />F-� 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 />❑I <br />❑ <br />