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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/17/19._._...... �......................... <br />Department Public <br />Name.....................................................S.cott Kr'eeger _.........._ � Works .............................._ <br />BPW Date 06/25/19 Phone Extension 9245 <br />�Wdtdglv.- �mur r i�un �... ... n,, wum�m v .wwrewtim„ »xmm� umunn wrva�sen�wrm ���wamar vrewax " " rcm�isvrmi�v <br />k..., _......�____�..._� .,�„� ...... .....W.. ................ ............. ,.a ,.. ....... �........ <br />lie u d Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney F] Attorney Name <br />Purchasing ❑ Michael Schmidt <br />.......... <br />Check the AppKopri to Item I pe _ Require ewrl iy- All Submissions <br />❑ Professional Services Agreement [❑ Contract <br />0 Open Market Contract <br />❑ Amendment/Addendum <br />E] Bid Opening <br />El Bid Award <br />Quote Opening <br />[l Quote Award <br />[ Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />0 Other: Agreement <br />Re uici red Information <br />IH Proposal <br />[❑ Special Purchase, QPA <br />El Req. to Advertise <br />[] Reject Bids/Quotes <br />0 PCA <br />Resolution <br />0 Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name Honc A�v ! [ International Inc. <br />New Vendor Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor MBE Completed E-Verify Form Attached Nos <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description Agreement authorizing,the entry uaa lte�roperty for the drill.ing a t <br />installation of monitoring wells for environmental remediation purposes at <br />Beiidix Dr. Soutly Bend IN, <br />.......... ........... <br />For Change Orders only <br />Amount of Increase $ <br />Decrease ($ <br />Previous Amount $ <br />Increase..............................................%....................................... ......�� ww�_.....__m.,,..............................................--------------- <br />.........P <br />_ <br />Current Percent of Change: Decrease 0/0 <br />---..�.. <br />�._ ._... <br />New Amount <br />Increase _ .......... <br />........� ��.......................................... ..... <br />% <br />Total Percent of Change: Decrease %) <br />Time Extension Amount: <br />New Completion Date: <br />