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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/16/2019^ <br />Department Public <br />Name Zach Hurst Worksmmmmm <br />BPW Date 04/23/2019 Phone Extension 3057 <br />ir��i� umimiv�wur rvrimnmm�mr�mwmuiNu�ow.w.uumoioioioioiwo mnwts�rrvni�,rm u�un�muuuuv�uuuuuuuuuuuuuuuuuuuuuuuuumuumww jwu iuuuuuI <br />ReVired Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Sandi Kennedy <br />Dept. Attorney Attorney Name <br />Purchasing El <br />_Check the A°o ' 1 Item lc lc� <br />[❑ Professional Services Agreement Contract <br />[] Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />n Quote Opening ❑ Quote Award <br />EI Proposal Opening ❑ C/O & PCA No. <br />El Chg. Order, No. ❑ Traffic Control <br />® Other: Temporary Storm <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 />re,d,lbr All Submissions <br />Information <br />Proposal <br />jam, Special Purchase, QPA <br />F] Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />❑ Ease./Encroach <br />❑ Title Sheet <br />Matthews LLC <br />ed b Yes ..If Yes'... Appro .................—' .......ym..Pu..........................._ —_ <br />rchasing <br />No <br />MBE <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Commerce Center <br />_.............................................................................................................. w w ..................................m. <br />119-030 <br />Agreement for temporary use of City storm sewer for parking lot located at <br />Madison Street near Niles Avenue. <br />_..._ww <br />.�.............................._......................................................... <br />............................................. ....... <br />For Cha.�.ne Orders Only .............e,_.. � ._.�. . <br />Amount of <br />Increase $ <br />n. <br />❑ <br />Decrease ($ <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ <br />��� � � � � �................................................. <br />Increase <br />_ _ ......................_ ................................................................................... _._................ <br />% <br />Total Percent of Change: <br />Decrease <br />.................................... _..�... — <br />Time Extension Amount: <br />New Completion Date: <br />.................................................................................................................................................................. .....�.�. <br />