Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 10/22/20'1.9 Phone Extension 3057 <br />om <br />Required Prior to Submittal to Board <br />... ..........................................._ ....... ............. <br />BPW Attorney Attorney Name <br />Dept. Attorney 0 Attorney Name <br />Purchasing 1:1 <br />Check the Appropriate Item fie'. Required �br° All Submissions <br />ProfessionalITServices Agreement Contract (1 Proposal <br />❑ Open Market Contract F-] Amendment/Addendum Special Purchase, QPA <br />❑ Bid Opening El Bid Award Req. to Advertise ❑ Title Sheet <br />® Quote Opening F Quote Award E] Reject Bids/Quotes <br />Proposal Opening C/O & PCA No. PCA <br />E] Chg. Order, No. Traffic Control ❑ Resolution <br />E] Other: ❑ Ease./Encroach <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 />ui ret Information <br />❑ Yes If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ No <br />❑ <br />WBE <br />Lafayette Building Cleanout <br />119-098 <br />RWDA TIF <br />324-1050-460-42.02 <br />Lump Sum <br />uote ro'ect to remove leftover oflic furniture, debris and broken Mass <br />arom the Lal�awte Building,, <br />For Cher ,orders Only www <br />Amount of Increase $ <br />w_w _ .............. <br />El Decrease ($ <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ( % <br />Time Extension Amount: . <br />,New Completion Date: <br />