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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/0 /2019 <br />Department Public <br />Name Kieran Fahey Works <br />BPW Date 2/12/2019 Phone Extension 5993 <br />lie ul,t'ed Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Clara McDaniels <br />...... _............ .. <br />Purchasing �] <br />1Il l� r <br />N Professional Services Agreement F-1 Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />El Quote Award <br />E] Proposal Opening <br />E! C/O & PCA No. <br />E' Chg. Order, No. <br />Fj Traffic Control <br />F Other: <br />l eauire Information <br />All Submissions <br />U Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />F1' Reject Bids/Quotes <br />(: PCA <br />❑j Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Clyde Wilber LLC <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE/WBE Contractor <br />❑❑ MBE s <br />Completed E-Verify Form Attached ❑ No <br />Project Name <br />Short-term LTCP assistance <br />Project Number <br />_......... <br />119-021 <br />Funding Source <br />�. __....._ _. <br />Wastewater <br />Account No. <br />................�.._ <br />641 0630-793.3,1' I �) -t <br />Amount <br />mmITmm <br />$20,000 .............. <br />Terms of Contract <br />Not to exceed the above amount <br />Purpose/Description <br />Additional and independent evaluation of LTCP and assistance on niche <br />renegotiation aspects. <br />Amount of H Increase <br />❑] Decrease ($ - <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ox <br />Time Extension Amount: <br />................... <br />New Completion Date: <br />