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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 5.2019 <br />Department Public <br />Name Kim Thompson Works <br />BPW Date June 11, 2019 Phone Extension 5969 <br />m � mwowowowuwuwwommmmu� <br />Required Prior to Submittal to Board <br />_...... .. ........ _........ .....__.. ....... ...... <br />BPW Attorney Attorney Name Clara McDaniel$ <br />Dept. Attorney ® Attorney Name Clara McDaniels <br />.........._.. <br />Purchasing 0 <br />Check the Appropriate <br />[] Professional Services Agreement ❑ Contract <br />Open Market Contract [] Amendment/Addendum <br />❑ Bid Opening [] Bid Award <br />Quote Opening R Quote Award <br />❑ Proposal Opening E] C/O & PCA No. <br />❑ Chg. Order, No. E] Traffic Control <br />Other: <br />Company or Vendor Name _ <br />New Vendor [] Yes[ <br />[ No <br />MBE/WBE Contractor MBE <br />[� WBE <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />All Submissions <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 />ui red Information <br />If Yes ApprovedPurchasing................................_-wwwwww�.�... ___ <br />pp b Y _........... r. _. <br />Completed E-Verify Form Attached El Yes <br />[: No <br />For Cha Orders-9-1ly— ... ...... <br />Amountof _ El Increase _$ _........................................................................ �_._........ <br />Decrease ($ <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 />Decrease_..-% <br />Increase <br />Decrease (WµmmmmWWW% <br />