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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />7-5-16 <br />AI Greek Department <br />Waterworks <br />BPW Date 7-12-16 Phone Extension 4210 <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Michael Schmidt <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller ® and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing ® <br />Roxanne Lawson <br />Check the Appropriate Item Type — Required for Ail Submissions <br />® Agreement <br />❑ Contract <br />❑ Proposal ❑ Addendum <br />® Professional Services <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Chg Order No. <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Ease./Encroach. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />El Claim <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Yes U It Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />WBE ❑ No <br />LCR and CIP Assistance On -Call Agreement <br />Other Prof Services <br />620.0640.658.31.06 <br />$ 150,000 Nj E <br />one year <br />the City and its residents to be in <br />compliance with the existing Lead and Copper Rule (LCR) as well <br />as the upcoming Long -Term Lead and <br />For Change Orders <br />Amount of <br />Increase <br />Decrease <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />PO No. <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />7 <br />