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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Mav 3. 2019 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date �Ma 144,2019 Phone Extension 9245 <br />....� ... _.....Re ut� ed Prior to Submittal <br />._.. ..................... <br />_...—,. <br />1 to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing �] <br />Check the A <br />Item Type ` Required.lbr All Submissions <br />Professional Services Agreement FI Contract <br />F-] Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />0 Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />E] Chg. Order, No. <br />® Traffic Control: <br />Residential [-ILnidicgp <br />P_ Lk <br />U 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 />Proposal <br />❑, Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />E] PCA <br />E] Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />❑......... Yes �0 If Yes, Approved by Purchasing....._...............�.�.......... <br />No <br />�] MBE Completed E-Verify Form Attached Yes <br />F] WBE ❑� No <br />442 S Jackson Street Residential Handicap Parking eeee. <br />Recommend Approval <br />__..._ ..... <br />For Cltat����Orders Only .. <br />Amount of F-1 Increase $ <br />1:1 Decrease ($ <br />Previous Amount $ <br />�. _..... ... o_�__w�._....�. <br />Increase /o <br />Current Percent of Change: Decrease /o <br />0 <br />New Amount $ _ <br />................................................. <br />Increase............................................................_w mm.................................................. <br />Total Percent of Change: Decrease %) <br />Time Extension Amount:. <br />New Completion Date: <br />