Department of Transportation and Development

REFERRED TO ______DEPARTMENT OF TRANSPORTATION AND REFERRED FOR ACTION DEVELOPMENT ANSWER FOR MY SIGNATURE FOR FILE FOR YOUR INFORMATION INTRADEPARTMENTAL CORRESPONDENCE FOR SIGNATURE RETURN TO ME PLEASE SEE ME PLEASE TELEPHONE ME MEMORANDUM FOR APPROVAL PLEASE ADVISE ME ______TO: Ms. Charlotte Garrison, CPPB Procurement Director BY ______DATE ______BY ______DATE ______BY ______DATE ______

FROM: Project Manager (name, title, contact number)

SUBJECT: Request for Professional or Consulting Service Contract – Title 39

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Project Name:

Project Background and Description of Services:

Term of Contract: (3 year) OR (12 months with option to renew 2 additional 12 month periods) Tentatively to begin on ______and end on______.

Expected amount of Contract: Means of Finance/Funding Source and Amounts:

Required attachments  Contract Draft  Cost Benefit Analysis  Outsourcing Key Control Memo  Letter from Contractor justifying unique capabilities, if applicable  Contractor’s LaPac vendor number, Current W-9 and Board Resolution

______RECOMMENDED FOR APPROVAL DATE

______APPROVED DATE