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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />May 10, 2019........................m._.._....... <br />Kara Bovles <br />Department Engineer <br />BPW Date <br />rua mimmiMa 14 2019 Phone Extension 5933 <br />urcmrmmrema wrnmu�mwiwmo�miomoiomuuwiuiuiumwuuuuuwimmmmmmuuuwimmmuiuiuiuiuuuiuuiuiuiu!�iuww su <br />..�.� ................................�.�. w. ...,�... �. ......_...,,..,._�,,........................... <br />ReuaITtcd Pnor to Submittal to Board -..... mIT <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney [-1 Attorney Name <br />Purchasing �.�..............................________�w <br />Check the A <br />Item Type — Requiredfiv All Submissions <br />® Professional Services Agreement Ef Contract <br />El Open Market Contract <br />Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />E] Quote Opening <br />E] Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />Chg. Order, No. <br />0 Traffic Control <br />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 />uired Information <br />[ J Proposal <br />[] Special Purchase, QPA <br />[] Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Arcadis <br />[ jYesEj If Yes, Approved by Purchasing <br />® No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />[ WBE ❑ No <br />i Assistance Utility Asset Management GIS/En a e�r� A <br />119-051 <br />SSDA TIF <br />430-1050-460.31-02 <br />?00 <br />�,�..4 months with ..... <br />3- <br />th additional on -call services as needed <br />w <br />For haOrders Qq l_n._. <br />Amount of El <br />Increase $ <br />.................. <br />ElDecrease <br />($ ) <br />Previous Amount <br />__ .......... <br />$ <br />�............. .................... _............................................ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />( %) <br />New Amount <br />$ <br />., <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( 0 <br />Time Extension Amount: <br />New Completion Date: <br />