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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6-4-19 <br />Name Department Utilities <br />BPW Date 6-11-19 Phone Extension 5969 <br />..... �. �._•. .�... ...__. �.._..... <br />Required Prior to Submittal to Board <br />y . .. _..... __..... <br />BPW AttorneyAttorney Name Clara McDu niels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the Apl~sar� tatc Item I pc 11(°clrvfin, All Submissions <br />LJ Professional Services Agreement Contract <br />El Open Market Contract ® Amendment/Addendum <br />[- Bid Opening ❑ Bid Award <br />El Quote Opening Quote Award <br />[ Proposal Opening E] C/O & PCA No. <br />r� Chg. Order, No. El Traffic Control <br />Other: <br />l cc( Bred Information <br />Proposal <br />Special Purchase, QPA <br />Req, to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease /Encroach <br />❑ Title Sheei <br />Company or Vendor Name <br />Systems and Software <br />.p ............._. �... . <br />Yes[ If Yes, Approved by............ <br />Purchasing <br />New Vendor <br />No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />Project Name <br />Project Number <br />Funding Source <br />n. ®.. <br />Water Works O&M <br />Account No. <br />�� .•w�_. ���� ��������� ��� _...., <br />620 0640-587 <br />Amount <br />_ <br />v $38,700 ...... _............ �.. _... <br />Terms of Contract <br />Purpose/Description <br />Amendment for S&S to complete business process __- _..m.ys �rel �� .o .......... <br />li <br />p p ss analysis related to poli <br />changes in response to HB 1347 (owner/tenant) for Utility CIS <br />project <br />_ <br />For "lrne Orders Only <br />Amount of <br />..-Increase.. $ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase o __---.... �..............�... <br />e /o <br />Current Percent of Change: <br />g <br />(1 - ..,....... �............ .... - .--__............. ,.. .W... .._•m_�... <br />Decrease /o) <br />New Amount <br />$ �....w.........•.. <br />...� _. •, ..�m��......•. _ . ..............•......•w_ <br />Increase /o <br />Total Percent of Change: <br />Decrease (%����-���' <br />Time Extension Amount: <br />New Comoletion Date: <br />