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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/14/19 <br />Name Lauren I" a Department Utilities <br />BPW Date 3/26/2019 Phone Extension 5852 <br />�.._.._. ._. ........ ........ -_ _ ...... _.............. <br />l �et��,d Prior to Submittal to Board <br />BPW Attorney [� Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the Afr rolariate Item 1 p . l , uir ed br� All Submissions <br />............ _._ ............... <br />❑ Professional Services Agreement E] Contract F] Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />E] Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheei <br />Quote <br />Opening in El Quote Award Reject Bids/Quotes <br />p Opening E] C/O & PCA No., PCA <br />❑ Chg. Order, No. E] Traffic Control ❑ Resolution <br />® Other: New Permit: Messer E] Ease./Encroach <br />LLC transferred from Linde <br />LLC <br />_-Required Information <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Yes If Yes, Approved by Purchasing <br />❑ No <br />❑MBE Completed E-Verify Form Attached ❑ Nos <br />WBE <br />For Clian <br />Amount of E❑ <br />increase <br />-($ <br />Decrease <br />Previous Amount <br />$ <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ <br />Increase ....................... <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />Ord rs o.n!y.. <br />