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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/4/19 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 3/12/19 Phone Extension 5998 <br />�R '. mmmn�au�mrv��m�wn��w�w� wmwaw,�nn�w���or�wrriudw�u�aRwuuu rsmuu�mwmuwwummmwwuuimmuuuuuuuuermmr�wrau�uuuc�au��o��+n: <br />Require Prior to Submittal to Board <br />BPW Attorney Attorney Name � �Clara M+cll►anicls � � �� ............��.____...����_.._. <br />Dept. Attorney Attorney Name <br />Purchasing El <br />Check the Appropriate Item Type _. <br />Professional Services Agreement ❑ Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />I Bid Award <br />❑ Quote Opening <br />Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />Other: <br />Reaoi:red Information <br />All Submissions <br />LJ Proposal <br />[] Special Purchase, QPA <br />F] Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />�] Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />American Stroctare°aarot, Inc. WWWWW mmm <br />EJ If Yes Approved b Purchasing <br />❑ Pp y mg <br />New Vendor <br />No <br />MBE/WBE Contractor <br />❑ MBE Completed E-Verify Form Attached El Nos <br />WBEProject <br />Name <br />West Side (quiet Zone <br />Project Number <br />117-114 <br />Funding Source <br />_ <br />LRSA Capital Projects <br />Account No. <br />251-0602-431.42-96 <br />Amount <br />$16,030.00 <br />Terms of Contract <br />. Cost per Unit Fee <br />Purpose/Description <br />A xreemenk with American Stqtr LcT,c it�t, Inc. for Right -of -Way isitioi <br />services within the West Side Qu gtITZone. <br />For Chanaze Orders OnI <br />Amount of El Increase $ <br />❑ Decrease ($ <br />�.�............�.................. m_ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease mm'► <br />Increase <br />Decrease m_.........% <br />