Laserfiche WebLink
�purte <br />OFFICE OF THE CONTROLLER ANDrt.�s/ <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM 1863 <br />Date 3/17/08 Department <br />Engineering <br />BPW Date Phone 9254 <br />Name Tony Molnar <br />o Legal ❑ Attorney Name: <br />o Cd -ti ❑ Controller review is required for all Contracts $5,000.00 or more and greater than one <br />O' <br />o Controller year in length per the City Purchasing Policy <br />W Other <br />3 Appropriate ❑ Other, as appropriate: <br />Reviewers <br />Type of Item ❑ Contract/Agreenient ❑ Proposal ❑ Addendum ❑ Claim <br />® Easement/Encroachment ❑ Resolution ❑ Traffic Control Device <br />❑ Other: - <br />- - <br />-------------------------------------------- - <br />E Company or Vendor Name Nature's Gate, LLC <br />Project Name Augustine Lakes Subdivision <br />aA <br />Q o Project Number (Engineering) <br />o_ a, Amount $ Funding Source <br />PurposefDescription: Access and lift station easement. <br />bO C-------------------------------------------- <br />U a Terms of Contract: <br />------------------------------------------------------------------------------------------ <br />Type of Item ❑ Advertise ❑ Bid Opening❑ Bid Award ❑ Quote Opening ❑ Quote Award <br />❑ Title Sheet ❑ Other <br />------- -------------------------- <br />Company Name <br />0 <br />Project Name <br />a' Project Number (Engineering) <br />Contract/Project Amount $ Funding Source <br />Type of Item Ch Order C/O & PCA ❑ PCA Other: <br />- ---------------- <br />Contractor/Consultant Name <br />lt� Project Name <br />Project Number (Engineering) PO Number <br />Amount of ❑Increase ❑Decrease $ Funding Source <br />Original Contract/Project Amount $ Current Percent of Change: <br />j U New Contract/Project Amount $ Total Percent of Change: % <br />Purpose/Description: <br />j List Name, Dept., Address (if appropriate) of who should receive document <br />Copy Original <br />e� o ❑ ❑ <br />