Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/31/2019 <br />Department Central Services <br />Name Adam Parsons <br />.... .. ............. <br />Division/Bureau <br />BPW Date 11/12/2019 <br />Phone Extension 9302 <br />mmmffl�M1111111101=�ZJXIWNJV�­ <br />_Rqqued <br />. . .. .ir..... - - - - -­­ . ... . ........ . .......... <br />Prior to Submittal to Board <br />Legal <br />Attorney Name: Clara McDaniels <br />Controller <br />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 El <br />k e c- k - the— A p . ...... - -------- —at - -1-t —e � rn­ � T —yp e Re wired -.,—fo —rA H Submission —-... s . .......... . . ..... . <br />Agreement Amendment <br />El Contract F] Proposal [] Addendum <br />F-1 Professional Services <br />FJ Resolution <br />F-1 Bid Opening <br />❑ Bid Award Req. to Advertise F1 Title Sheet <br />F-1 Quote Opening <br />Quote Award <br />F-1 Change Order No. <br />F-1 C/O & PCA No. El PCA <br />El Ease/Encroach. <br />F-1 Traffic Control: <br />Other: <br />— - — - <br />— <br />............... . . ...... . <br />­­­­­Reciuired Information <br />Company or Vendor Name <br />D.A. Dodd <br />❑ Yes H No E] If Yes, Approved by <br />New Vendor <br />MBE/WBE Contractor <br />MBE [I WBE <br />MBENVBE Contractor Requested <br />N ...... . ........ ............ <br />No 0 Yes Name of Company <br />............ . ..... . ...... <br />Project Name <br />City -Wide Plumbinci Contract <br />. . ................ .......... . <br />Project Number <br />. .. . ... . ........ ............. <br />Funding Source <br />Department Building Maintenance Budgets <br />Account No. <br />Various <br />Amount <br />TBD ....................... <br />Terms of Contract <br />3 year initial contract: 2 year renewal option, <br />Purpose/Description <br />cityjiribina reDairs under <br />fa��y.plumone contractor <br />Standardize .. _ ... .. . <br />Required Contractor's Certification Forms Attached (Non- <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />. . ... <br />... .. ........ <br />_,"Reqgired For Cha,!19,q Orders OnI y <br />Amount of El increase ................ <br />[:] Decrease <br />Previous Amount <br />............ . . . ............. <br />Current Percent of Change- % <br />New Amount <br />Total Percent of Ch�n eL__ % <br />Dispersal After Approval <br />Copy Original <br />F-1 ❑ <br />F] <br />