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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date _ April 1 ,, '0ul ........................... <br />Department Public <br />Name Roger Nwrot Works <br />BPW Date Aril 23 2019 Phone Extension 5932 <br />Required. Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney R Attorney Name <br />Purchasing <br />the Appropriate Item Type — <br />❑! Professional Services Agreement F-1 Contract <br />E] Open Market Contract ❑ Amendment/Addendum <br />F <br />Bid Opening F-I Bid Award <br />❑ <br />Quote Opening F-I Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. ® Traffic Control <br />[l Other: <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 />Proposal <br />LJ Special Purchase, QPA <br />E] Req. to Advertise ❑ Title Sheet <br />0 Reject Bids/Quotes <br />F] PCA <br />Resolution <br />Ease./Encroach <br />Yes U If Yes, Approved by Purchasing <br />No <br />[] MBE Completed E-Verify Form Attached ❑ Yes <br />n WBE No <br />Sheridan Street & Brentwood Drive 2-way Stop <br />TR 19-015 <br />311 call requesting that the yield signs at this intersection be changed to stor <br />signs <br />For Chri Orders Oita <br />Amount of El Increase $ <br />❑ Decrease <br />Previous Amount $ <br />_._ ........ <br />Increase % <br />Current Percent of Change Decrease ( %) <br />New Amount $ <br />...... _ ................... .. .......... <br />Increase % <br />.-.. .�... _o .... .......... __ ............... <br />Total Percent of Change: Decrease (..__.. ) <br />Time Extension Amount: <br />New Completion Date: <br />