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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date ,June 18019 <br />Name Charlotte Brach Department En inc r <br />BPW Date oJune 019, Phone Extension 9246 <br />Re uired Prior to Submittal t ... -. <br />....� .......��. _.._ ..........___ �........�.�._w_..�9 � o Board ....-�..__.._..�...._... � � _ ���. <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑] <br />Check the Appropriate Item Type - <br />F Professional Services Agreement ❑ Contract <br />0 Open Market Contract <br />Amendment/Addendum <br />Bid Opening <br />Bid Award <br />Quote Opening <br />® Quote Award <br />E] Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />❑] 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 />Information <br />& Son LP <br />All Submissions <br />Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />E] PCA <br />Resolution <br />Ease./Encroach <br />YesLJ If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />MBE Completed E-Verify Form Attached Yes <br />WBE ❑ No <br />11 clr alit I Iow `l c wing <br />119-041 R <br />Water Works Professional Services <br />620.0640.658.31.02�._............................�..................... <br />$37,145.00 <br />Base Quote <br />._ .. __ mm ___:...__._...:_..... _.... <br />. For Chang <br />Ordere .......... <br />Amount of <br />Increase $ <br />El <br />Decrease ($ <br />Previous Amount <br />$ <br />............ _. .. <br />Increase <br />m. ........__w <br />% <br />Current Percent of Change: <br />Decrease <br />( /o�-� <br />o <br />New Amount <br />$ <br />Increase........................................................................................ <br />_ <br />_._................................�....... ��..................���......r�..... <br />Total Percent of Change: <br />Decrease <br />( %) <br />Time Extension Amount: <br />New Completion Date: <br />