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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Febr ar 2'7 019 <br />Name EKara B� i�. pEngineer <br />BPW Date 4Phone Extension 5933 <br />�� 'or to Submittal to Board <br />B PW A to rney Name Clara M. �y Atto <br />Dept. Attorney 0 Attorney Name <br />Purchasing <br />Check the Appropriate Item Type <br />....................... <br />Professional Services Agreement Contract <br />❑ Open Market Contract ® Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />❑ Quote Opening [:]'Quote Award <br />Proposal Opening C/O & PCA No. <br />Chg. Order, No. Traffic Control <br />Other: <br />RNuired Information <br />All Submissions <br />Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Company or Vendor Name <br />CBBEL <br />_ <br />oved b Purc�_.._....,...�__..... <br />--® Yes If Yes Appr y Purchasing <br />New Vendor <br />, <br />No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached ❑ No <br />Project Name <br />Based Stormwater Utility Phase 2 <br />erviousyCover. - ,.... <br />Project Number <br />... <br />119- 110 <br />Funding Source <br />Stormwater Fund Professional Servi'c`es ,-- .. �... m.....�� .... <br />Account No. <br />667-0621-792.42-04 <br />Amount <br />._ <br />$40 000• T <br />Terms of ct <br />1 et <br />eted by er ��mmmmm <br />Purpose/Descriptionra <br />��� mm <br />Identify stormwaOterobSc0osts and develop <br />y program rate structure and fee with <br />recommendations for implementation <br />For Clunge„Orders Onl <br />Amount of <br />Increase $ <br />Decrease <br />) ...._� <br />Previous Amount <br />$ �.��..........�.......� <br />Increase <br />ease <br />. <br />..................... ..................�.�.........� <br />o <br />/o <br />Current Percent of Change: <br />Decrease <br />( /o) <br />New Amount <br />$ <br />Increase <br />/o <br />Total Percent of Change: <br />Decrease <br />( %) <br />Time Extension Amount: <br />New Comnletion Date: <br />