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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 7, 2019 <br />Name Charlotte Brach Department Engineer n <br />BPW Date Max 201N�ro�Phone Extension m 9246 <br />mmmm�m�mmm..� <br />�.. ............. �.� to Board <br />Re �u���.d Prior to Submittal � ..__.. <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing (� <br />Check the Apnronria:te Item Tyne <br />Professional Services A eement .. ._ ..... <br />Contract gr, <br />Open Market Contract <br />❑ Amendment/Addendum <br />[� Bid Opening <br />❑ Bid Award <br />FJ Quote Opening <br />Quote Award <br />Proposal Opening <br />E, C/O & PCA No. <br />❑ Chg. Order, No. <br />[:] 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 />urud Information <br />All Submissions <br />Proposal <br />LJI Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />N/A <br />Yes �.�. .... ....� . �..��.....� �.. <br />If Yes, Approved by Purchasing <br />No <br />❑ MBE WBE Completed E-Verify Form Attached Yes <br />No <br />Hydrant Flow Testing ............._....... �.. _....� <br />119-041 <br />Water Works Professional Services <br />620.0..................... <br />658.31.02 <br />N/A <br />Base mm0uo ..........�... .�.........��.w <br />to <br />For Chre Orders On <br />Amount of Increase $ <br />Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease (..„mw ��� % <br />Time Extension Amount: <br />�...............�w ...............m .._ <br />New Completion Date: <br />