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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date AUH12, 2019 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date ARHI 9, 2019 Phone Extension 9245 <br />=�EMHMMMMMMMMM <br />I Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara MeDaniels <br />Dept. Attorney 0 Attorney Name <br />Purchasing M Michael Schmidt <br />Check the Appropriate Item Type — RequiredLor All Submissions <br />Professional Services Agreement [:] Contract 1:1 Proposal <br />[❑ Open Market Contract ❑ Amendment/Addendum [:] Special Purchase, QPA <br />E] Bid Opening Z Bid Award Z Req. to Advertise ❑ Title Sheet <br />Quote Opening n Quote Award E] Reject Bids/Quotes <br />Proposal Opening CIO & PCA No. E] PCA <br />E] Chg. Order, No. ❑ Traffic Control Resolution <br />[:J Other: Ease./Encroach <br />Information <br />Company or Vendor Name Multiple <br />New Vendor E] Yes F1 If Yes, Approved by Purchasing <br />R No <br />MBE/WBE Contractor MBE Completed E-Verify Form Attached E]Nos <br />Project Name 2019 Street and Sewer TPe arjment Materials <br />. . .. .. ..... . ........................................ . . . ............ . . . . . . . . . . . . <br />Project Number 119-008 <br />Streets, Curb & Sidewalk, Sewer Concrete,""... . Sewer . Ins, . W .. at . e . r W .. o .. r . ks .................. <br />Funding Source Parks <br />202-0607-431.22-24, .22-30, .22-40, .23-02, .23-03, 23-20, 23-40,39-89, <br />641-0621-792.22-24, .23-02, .23-03, .23-04, 202-0619-431.23-03,.23-24, <br />641-0625-792.22-24,.23-04, 640-0620-811.22-24,.23-04, 620-0640- <br />Account No. 606.23-30,201-1101-452.39-89 (Proj Code K61RMT) <br />Amount <br />Terms of Contract Unit Price <br />Purpose/Description Award Divisions A, B, C, D, E, F, G, and I <br />Reject Divisions H, and J <br />Amount of <br />Previous Amount <br />Increase <br />❑ Decrease <br />Increase % <br />..................................... <br />Current Percent of Change: Decrease % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />