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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date -April 19 2019 <br />Name David Relos Department DCI <br />�fffiBPW Date IT , e[o,-.e[;Y°, usrsc:saarnaNPS�;&xa11IIIIIIIIIIIIIIIIIIIIIIIIIIItlIItlIII�I�M W.'mkNVWxNffi5��5v,.mvmnvviFAniXl�Hn Phone Extension+MTV:WWlffiiWVGWWWWVW!IYW➢N'IW!W!W <br />6 2019 <br />!'�Yd 5 <br />.�� <br />........ °�... t�u����Prior or to Submittal to,Bo...ard <br />............ .......... - -.. <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney M' Attorney Name Sandi Kennedy <br />.......... -- <br />Purchasing ❑ <br />Services e A props t Item 'l yl e l cxc w <br />Professional rces Agreement <br />ee ° ��- gr ment Contract <br />❑I Open Market Contract ❑ Amendment/Addendum <br />EI Bid Opening (] Bid Award <br />❑ Quote Opening ❑ Quote Award <br />Proposal Opening ❑ C/O & PCA No,. <br />El Chg. Order, No. Traffic Control <br />0 Other: <br />ared /cat All Submissions <br />uired Information <br />LJ Proposal <br />(� Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />(] PCA <br />R Resolution <br />Ease./Encroach <br />Company or Vendor Name lotarcrrrm,° lcrrectt " yF �r <br />New Vendor Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor ❑ MBE <br />Completed E-Verify Form Attached <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Charles Martin Sr. Drive dedication <br />/ EDIT <br />COIT.................... <br />408-1050-460-31.11 <br />80 <br />❑ Title Sheet <br />C_C V\P- r <br />El Yes <br />No <br />so C <br />Survey services to vacate alleys, prepare legal descriptions, create outlots, <br />and ultimately dedicate the street. <br />�.��......._. . __............w_ . <br />For � antic Orders Only <br />Amount of ❑❑ <br />Increase ,,. ..�_ <br />-... __.n,..... <br />Decrease $ ) <br />Previous Amount <br />$ .....----- <br />_ ..-. <br />Increase <br />m..... ..................... - - - — <br />o <br />Current Percent of Change: <br />Decrease <br />�... ......... -- - . _m.,......_ ........ ............___. __... <br />%) <br />New Amount <br />.......... .. <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />�.... .._ ----- .n_ �� .............�.— <br />%)_ <br />Time Extension Amount: <br />...... - _..._.__.._ <br />New Completion Date: <br />