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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 6, 2019 <br />Name Kara Bolles Department Engineer <br />BPW Date Ma 14 2019 Phone Extension 5933 <br />m urumr v M ummwu mmmimiwmmmmmmmmmmmmmuimuimu iIMMMmu uuuuuuuuuumn <br />Required Prior to Submittal to Board <br />BPW Attorney <br />® Attorney Name _ Clara McDaniels ._....._............. <br />_...... <br />Dept. Attorney <br />Purchasing <br />El <br />Check the A <br />Professional Services Agreement <br />U Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑' Proposal Opening <br />Chg. Order, No. <br />D 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 />Attorney Name <br />.le Item' e — <br />Contract <br />® Amendment/Addendum <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />�I Traffic Control <br />St. Jost <br />Yes <br />15� No <br />Information <br />All Submissions <br />LJ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />If Yes, Approved by Purchasing <br />❑ Title Sheei <br />❑ MBE Completed E-Verify Form Attached ❑❑ Nos <br />❑ <br />WBE <br />First Amendment to MOU for Portage Avenue Bridge Replacement <br />RWDA TIF/Special LOIT <br />324-1050-460.42-03 / 257-0608-431.31-06 <br />Amount $58,205 RWDA TIF / $3749.15 Special LOIT: Total $61,945.15 <br />...�..._ � <br />Terms of Contract Payment will bemadeonce approved b _..... �—___ .—...� <br />Purpose/Description City's cost related to a change order for requested elements of work as part <br />the County's project <br />_. <br />For Chan Orders 1 ly. <br />...._.� . _ — — .... �w....w . mm._._....... <br />Amount of El Increase $ <br />El Decrease * ) A, �........ ..... ���� <br />($ �. ���.�.,,�.......... ........�. <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease ( %) <br />Increase % <br />................. <br />Decrease ( % <br />