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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 17„ 2019 <br />Department Admin & Finance — <br />various department <br />Name Maricela Juarez requests <br />BPW Date 12/19/19 Phone Extension 9953 <br />„W„ <br />Reauired Prior to Submittal 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 />Agreement <br />El Professional Services <br />Bid Opening <br />Quote Opening <br />❑ Chg Order No. <br />Ease./Encroach. <br />Other: Disoosal <br />pro riate Item Type — <br />E Contract <br />❑ Amendment <br />❑ Bid Award <br />Quote Award <br />F] C/O & PCA No. — <br />F Traffic Control <br />Company or Vendor Name <br />New Vendor F1 Yes <br />[:] No <br />MBE/WBE Contractor [:1 MBE <br />❑ WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />for All Submissions <br />Proposal Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />PCA <br />Resolution JJ6 <br />Claim <br />Information <br />If Yes, Approved by Purchasing <br />Completed E-Verify Form Attached ❑ Yes <br />❑ No <br />For Chahge Orders Only <br />Amount of ❑ 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 />El <br />F-1. <br />