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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/06/2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 05/14/2019 Phone Extension 3057 <br />uu�orcurammmrammmr nn,aanw�nrumaaax imuuiuiuimmmmmuiuiuiuiuiuiuiu��wwru� <br />Required Prior to Submittal to Board <br />_W ............. ..... ....ww__._......._................_... ... . .......... �._. <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ® Attorney Name Sandi Kennedy <br />Purchasing........__........_......_....__���__..........__.................................._�_w �_.��... <br />El <br />Check the Appropriate Item Type -- l equired fin- All Submissions <br />Professional Services Agreement ❑ Contract <br />E] Open Market Contract <br />El 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 />® Other: Dedicated <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 />Required Information <br />LJ Proposal <br />EI Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />[❑ PCA <br />Resolution <br />F1 Ease./Encroach <br />❑ Title Sheet <br />Matthews LLC <br />Yes If Yes A roved b Purc ....���� <br />.. <br />h.. .... <br />PP Y sing �...... <br />E] No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Commerce Center <br />....... . <br />119-030 <br />Dedicated Improvements agreement between Matthews LLC_and City to <br />ensure Tg ncr Igcg9r struction o C y rights -of -way. <br />.. ... <br />.... For C h,an c Orders Or l y mm <br />Amount of <br />Increase $ .. ... <br />.... ..._..... �... ��....mmm. <br />Decrease ($ ) <br />Previous Amount <br />$ ...........................�.�.�.�.�.�.�...................................................o <br />Increase <br />��.�..�......................................................._� ,,,,,,,_A..� <br />�o <br />Current Percent of Change: <br />Decrease ( <br />%)m <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />�...... <br />Decrease ( <br />........... <br />%) <br />Time Extension Amount: <br />New Completion Date: <br />