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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/8/20 <br />Name Kyle Silveus <br />Department Engineering <br />BPW Date 7/14/20 <br />Phone Extension 9083 <br />Required Prior to Submittal to Board <br />Legal ❑ <br />Attorney Name <br />Controller ❑ <br />Controller review is required <br />for all Contracts $5,000.00 or more and <br />greater than one year in <br />length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Required <br />for All Submissions <br />❑ Agreement <br />® Contract <br />❑ Proposal ❑ Addendum <br />® Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Change Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease/Encroach. <br />❑ Traffic Control <br />I-1 Other: <br />Required Information 1 <br />Company or Vendor Name <br />Epoch, a Division of Shive- <br />Hattery,Inc. <br />New Vendor <br />❑ Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE ❑ WBE <br />Project Name <br />Main St. & Wayne St. Garage Improvements <br />Project Number <br />119-066 <br />Funding Source <br />RWDA <br />Account No. <br />324-1050-460-42.02 <br />Amount <br />$ 66,940.66 <br />Terms of Contract <br />Lump Sum <br />Purpose/Description <br />Design Services <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />Required For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Dispersal After Approval <br />Copy Original <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />