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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/1/2019 <br />Name Lauren `I"ra Department Utilities <br />BPW Date 5/14/2019 Phone Extension 5852 <br />mmuimwuwiuiuiuiuiuiuimuimuwiuiuiuiuiuiuiuiuimuwiuiuiuim,www,� rmr�,��r�r� m nmaevZ.11rcr v w00000l0000mm <br />_............ ........._�,� .._..,_...........______...... .... ........... <br />._,.m.,,..._................��......,,.,. <br />_. _Requi med Prior to Submittal to Board <br />�.� ....... �........._._m....._ <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the <br />Item Type - Re uired„, br All Submissions <br />LJ Professional Services Agreement Contract Proposal <br />Open Market Contract El Amendment/Addendum EJ Special Purchase, QPA <br />E] Bid Opening E] Bid Award ❑ Req. to Advertise ❑ Title Sheei <br />Quote Opening Quote Award Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. PCA <br />El Chg. Order, No. Traffic Control ❑ Resolution <br />El Other: Renewal of Industrial ❑ Ease./Encroach <br />Di cha M, Permit for <br />Somaschini <br />Required Information <br />Company or Vendor Name <br />New Vendor ❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ MBE Completed E-Verify Form ❑ <br />Attached ❑ Nos <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />�.............W__ <br />_ For Change Orders Only <br />Amount of Increase $ <br />Decrease ($ ) <br />Previous Amount $ <br />IncreaseA,...............................� .�.� .�.�.�........%...� <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ( % <br />Time Extension Amount: <br />New Completion Date: <br />_. .— ...a.....—..� -� ����................................ ...... ... ... <br />