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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date06/04/2019................................................................................................... <br />Department Public <br />Name Zach Hurst Worl s / En ineerin <br />BPW Date 06/11/2019 Phone Extension 3057 <br />lac testai Prior to wSubmittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ❑ <br />Check the <br />Item Type ... Re uired �br All Submissions <br />El Professional Services Agreement ❑ Contract <br />Open Market Contract <br />® Amendment/Addendum <br />E] <br />Bid Opening <br />❑ Bid Award <br />Quote Opening <br />EJ <br />Quote Award <br />Proposal Opening <br />[—] <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />E] <br />Traffic Control <br />F� Other: <br />Company or Vendor Name <br />Information <br />Architecture + Plann <br />❑ Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />Yes � If Yes, Approved by Purchasing <br />New Vendor ❑ No <br />MBE/WBE Contractor ❑-1 MBE 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 />❑ Title Sheet <br />❑ Yes <br />❑ No <br />Amendment No, 2 for architectural,desioi and construction administration <br />services. <br />For ChangeOrdersOnly <br />Amount of El Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease o ��.....................................................................................�__�W <br />Time Extension Amount: <br />New Completion Date:m ... <br />