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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />9/19/18 <br />Denise Zigler Department <br />BPW Date Phone Extension <br />Morris/Palais <br />❑ Agreement pFp ❑ Contract U Proposal ❑ Addendum <br />X❑ Professional Services ❑ Amendment <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Chg Order No. ❑ C/O & PCA No. ❑ PCA <br />❑ Ease./Encroach. ❑ Traffic Control ❑ Resolution <br />n Other: I —I Claim <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />❑ Yes El If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑Yes <br />❑ WBE ❑ No <br />Morris/Palais Housekeeping agreement <br />Box office funds <br />Cleaning of Morris/Palais after events <br />Increase $ <br />Decrease $ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount $ <br />Total Percent of Change: <br />Time Extension: <br />ispersal After Approval - <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />