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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/14/2019 <br />--�... _ ..... <br />Name Lorl Timmer Department DCI <br />BPW Date 6/25/20/19 Phone Extension 5841 <br />­__ ...... ........ _......... _... _...... <br />�.._. �. <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ® Attorney Name Sandra Kenned <br />Purchasing ® Michael Schmidt <br />Check the A <br />m Typelri°rl,r_All Submissions <br />Ite....., �__ _ ...... - <br />Professional Services Agreement ® Contract <br />E] Open Market Contract <br />❑I Amendment/Addendum <br />EJ Bid Opening <br />Bid Award <br />EJ 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 />quired Information <br />❑ Proposal <br />❑ Special Purchase, QPA <br />E Req. to Advertise <br />E Reject Bids/Quotes <br />0 PCA <br />E] Resolution <br />0 Ease./Encroach <br />Near Northwest Neiglib., r hood, Inc. <br />El Yes[:] If Yes, Approved by Purchasing <br />® No <br />For Clti� Orders Only <br />❑ Title Sheei <br />Amount of E] Increase $ .r....................... <br />........ <br />Decrease._...... $............... .......... ............................................................. .................................................................. _.__................ ._............... .m....... .... ............ ._................ <br />,..... <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 />% <br />Decrease <br />% <br />...... .......... ............. <br />Increase <br />---.._....._._..._._ <br />% <br />Decrease <br />1 % <br />