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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />April 16, 2019 <br />Sandra <br />Department Legal <br />BPW Date Aril 23 2019 Phone Extension x9294 <br />mMMffl ummmmm i e <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ® <br />Attorney Name <br />Clara McDaniels <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type <br />- Required for All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />Proposal <br />❑ <br />Open Market Contract <br />F] <br />Amendment/Addendum ❑ Special Purchase, QPA <br />❑ <br />Bid Opening <br />D <br />Bid Award <br />❑ Req. to Advertise ❑ Title Sheei <br />❑ Quote Opening <br />F1 <br />Quote Award <br />Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />F] Traffic Control <br />❑ Resolution <br />® Other: Rescission of <br />❑ Ease./Encroach <br />AI)roval of Contract <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 />Information <br />Line Landfill Partnership (Republic Services <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached <br />WBE <br />Waste Water ............... <br />641-0630-793.63-36 <br />❑ Yes <br />❑ No <br />Purpose/Description The Le ag 1 Department asks the Board of Public Works to rescind its a ,ro, <br />of the mein nt .for Services, By....and Betw �a.�� Citt of outh .aril( <br />Indiana and County Line Landfill Partnershi for the reasons stated in the <br />attached memorandum. <br />For �l an em Ordersi�a��l. ._.. ...... <br />Amount of......._.......... _... E] mIncreasemm $ .��.. .�. ......... .._._.�._ ......... ........� ............... <br />Decrease ($ <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease( %) <br />New Amount $ _ <br />Increase_........�.........�_............o/o............. .....�...w� w .w�........ w_.w�. <br />Total Percent of Change: Decrease ( %) <br />Time Time Extension Amount: <br />New Completion Date: <br />