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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/25/19 <br />Name Alicia Czarnecki Department Engineering <br />BPW Date 05/14/19 Phone Extension 5903 <br />...............m <br />mmITITITITITITIT�ITITITITITITITITITIT��� Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing 1-1 <br />Check the Appropriate Item I'yp ,— <br />f-j Professional Services Agreement E] Contract <br />❑j Open Market Contract <br />❑ <br />Amendment/Addendum <br />❑ Bid Opening <br />F-1 <br />Bid Award <br />❑ Quote Opening <br />n <br />Quote Award <br />Proposal Opening <br />E] <br />C/O & PCA No. <br />E] <br />Chg. Order, No. <br />0 <br />Traffic Control <br />® Other: <br />Information <br />Company or Vendor Name <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 />New Vendor L_J YesLJ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor MBE E] 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 />Amount of <br />Previous Amount <br />Morris Theater Emergency Plaster Work <br />118-094 <br />................................ <br />VPA Morris <br />226-0419-672.36-01 <br />K Title Sheet <br />El Yes <br />0 No <br />Restoration work of the plasteifrieze at the perinneter of finir domes at <br />Morris Performin a Arts Centei`. <br />a <br />El Increase <br />Decrease <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />For Chap ,Orders <br />HE <br />Increase <br />..................... ....�%...... .. <br />.. - <br />Decrease �_ .. <br />_......................... _ ........................... <br />Increase % <br />_ <br />Decrease 1 %l ..... <br />