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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 a 14, 2019 Phone Extension 9245 <br />w� MwrmuwAmmnmmnmmnmmmmmmuuummmmmmmmmmmmmmmm io�r;�wu r�5555oommmmmmmmNwiwwa ueuMa <br />. �..W... ,,. ......._,.�.�......... _.�w�,,, .................�. __......... <br />—.w..�.. <br />R�t�trcm,Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing �] <br />_... _ Check the Approprzat: Item l ape <br />E] Professional Services Agreement ❑ Contract <br />Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening Bid Award <br />❑ Quote Opening El Quote Award <br />Proposal Opening [:] C/O & PCA No. <br />❑ Chg. Order, No. ® Traffic Control: <br />.Resi Nential Handicap <br />ar inl <br />Lj 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 />ui red Information <br />All Submissions <br />LJ Proposal <br />[J Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />[-] PCA <br />F-] Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />H Yes U If Yes, Approved by Purchasing <br />Fj No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE No <br />Brookfield St Residential Handicap Parking <br />Recommend Approval <br />......... __ <br />For Changg Orders Onty <br />Amount of El Increase $.... <br />Decrease J$ <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />% <br />Decrease. <br />...�.�.......�.......% <br />Increase <br />/o <br />Decrease <br />( % <br />