Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 17, 2019 <br />Name Alicia Czarnecki Department En ineerfn °W "ire <br />BPW Date ,l'aane, 2 �I119 Phone Extension 5903 <br />uuuuuuuuuuww�rnrsiaamuw�mr�o��v ���AU ae��y,�r� mww!w nrn�ramar�... �.—.�n, .r�m�a0000mmm000�mmmimwm <br />.�..... ..... ... .. ........... <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the <br />Professional Services Agreement <br />L j Open Market Contract <br />Ej Bid Opening <br />R Quote Opening <br />❑] Proposal Opening <br />Chg. Order, No. <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 />ate Item T)Te _. <br />I Contract <br />Elliot Anderson <br />❑ Amendment/Addendum <br />❑] Bid Award <br />E] Quote Award <br />C/O & PCA No. <br />Traffic Control <br />Information <br />All Submissions <br />LJ Proposal <br />EJ Special Purchase, QPA <br />Req. to Advertise <br />EJ Reject Bids/Quotes <br />PCA <br />[� Resolution <br />Ease./Encroach <br />Shive-I.lattery <br />El Yes If Yes, Approved by Purchasing <br />® No <br />❑ Title Sheet <br />For Change <br />OrdersmOnlyw <br />Amount of <br />El <br />Increase $ <br />-.----- <br />E] <br />Decrease ($ <br />) <br />Previous Amount <br />............... <br />$ <br />�..............................................._.._...... <br />Increase <br />% .. <br />Current Percent of Change: <br />Decrease <br />���w.....,u............... __........... <br />( %) <br />_._.... <br />New Amount <br />$ <br />............... <br />.I <br />e <br />Increase <br />° �. �........ ��. <br />/o <br />Total Percent of Change: <br />Decrease <br />( %) <br />Time Extension Amount: <br />New Completion Date: <br />. ......... —.__�._�e..........�. <br />