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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 3/19/19 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 3/12/19 Phone Extension 5998 <br />��o��� NNvivi arrmmo�wm�o��� �mYer¢.... muuuum �wavmmmumuuumr�uu��rsrawu,�mmmmumumuuuuuuuuuuuuuuuuuuuuumwmummmumNm�mr��rt�uuumrc�wrd�vauv uemrw,�m�oaumuwu�wwwwomommmmomow <br />Required Prior to Submittal to Bo ..................... <br />and ...�_._� w__._.........._ W ....�.__ __ <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney -1 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 />❑ Bid Award <br />❑ Quote Opening <br />[] Quote Award <br />[❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ Chg. Order, No. <br />Traffic Control <br />ElOther: <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 />Information <br />All Submissions <br />U Proposal <br />E]Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />®_ PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Peerless Midwest <br />.................. <br />Yesf. Yes, <br />ww......��.......� �.... �._...........................................�..._................... <br />Approved by Purchasing <br />® No <br />[❑ MBE Completed E-Verify Form Attached El Yes <br />WBE ❑ No <br />Olive Production Well #6 Rehabilitation <br />118-102 <br />Water Works O&M <br />620-0640-602-31-06 <br />$63,237.00 <br />_ <br />Hourly Not to Exceed, _ Lump....Sum. <br />The close out of the Olive Production Well #6 Rehabilitatimon................................m� <br />For Chrnp..OrdersmQnl...._.. <br />Amount of <br />F1 <br />Increase $ <br />F <br />Decrease $ � <br />Previous AmountIncrease <br />$ <br />�...................... <br />Current Percent of Change: <br />Decrease <br />A,_...........................................���.......................... <br />( /o) <br />New Amount <br />$ <br />.m........�__ .�s_� <br />Increase................................�..................................................%..............................�w��� <br />_��.�.�.�.�...... �........................................ �........_... <br />Total Percent of Change: <br />Decrease <br />_(OR 0 <br />Time Extension Amount: <br />New Completion Date: <br />