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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Mav 3, 2019 <br />Name Scott <br />Department Public <br />Works <br />BPW Date Ma , 2019 PhoneExtension 9245 <br />mmro,�rrwamuu 14mm,uamair�tirmern"umrrai nrvmnooimmoo�m0000mmm0000immmmmuuuuuuuuuuuuumumummmmmm enson mwNNuimuioioioimi....,. y�rmu®®®uuu�uwerere�i <br />�. ........ .................. _ ... „__................., .......... ..�.�........................� ..._..�....�..�.,.._._..�.. <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ❑ <br />Check the Aplaropriate Item Tye - l equired./ i- All Submissions <br />H Professional Services Agreement Fj Contract <br />Open Market Contract <br />[] Amendment/Addendum <br />Bid Opening <br />F] Bid Award <br />Quote Opening <br />F-1 Quote Award <br />F-] Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />® Traffic Control: <br />sic�entjal Handica <br />Parking <br />II P 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 />Information <br />LJ Proposal <br />Special Purchase, QPA <br />El Req. to Advertise <br />F Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />YesU If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />WBECompleted E-Verify Form Attached 11 11 Nos <br />522 S Falcon St Residential Handicap Parking <br />.Recommend Approval. <br />_.....W_ -- <br />For Cla.���em Orders Only <br />Amount of <br />El <br />Increase $ <br />❑ <br />Decrease($ ) <br />Previous Amount <br />$ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease W (......�......._ <br />�.� �._.... ........ <br />%) <br />New Amount <br />$ <br />Increase. <br />W. ...... <br />Total Percent of Change: <br />Decrease <br />%)............................................................................w <br />Time Extension Amount: <br />NewCompletionDate: <br />