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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />F❑ Bid Opening <br />❑ Quote Opening <br />Proposal Opening <br />Chg. Order, No. <br />w Other: Emergency Main <br />to Item Type _..- <br />Contract <br />Date 4-30-19 <br />Name Scott Horvatti Department Water <br />BPW Date 5-14-19 Phone Extension 5665................. <br />ixrm �mxramomeww mmuuuuuuuuuummmmmm momomom� <br />.... _ e uired Prior to Submittal to Board .. ..............._ <br />BPW Attorney ® Attorney Name <br />Dept. Attorney Attorney Name <br />.......... .... _.mm ............... <br />w <br />Purchasing; <br />Check the <br />Professional Services Agreement <br />Open Market Contract E Amendment/Addendum <br />E] Bid Award <br />F-1 Quote Award <br />F-IC/O & PCA No. <br />n Traffic Control <br />Required Information <br />All Submissions <br />L_ JI Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />[—] PCA <br />Resolution <br />0 Ease./Encroach <br />❑ Title Sheet <br />Company Construction <br />an or Vendor Name Sel _ .m_ .�.................................. .......... <br />New Vendor .....� <br />Yes[7 If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Project Number <br />Funding Source Water Works O cratinsFund.............. _.._______. <br />Account No. 620-0640-606-31-51 <br />Amount $10,533.64 <br />..__... ............mw_................ .. _......_____... ...... ...m��__ mm._._...� ........... � ..._ <br />Terms of Contract _ <br />Purpose/Description This was an emergency repair that had to be done immedi <br />ately, <br />........._. _ For Ch <br />allEl Orders Only .... _......_... Amount of Increase $ <br />Decrease ($ ) <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Comaletion Date: <br />E19 <br />Increase % <br />Decrease ( _..-% <br />Increase % <br />Decrease ( %) <br />