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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 182019 <br />Name Charlotte Bra ch Department Engineering <br />BPW Date June 25 2019 Phone Extension 9246 <br />uwmwmmmrnrimiwwwrvimimimimwiwnimmawa�mumw.wmwwnn�i®e�..m++� �� �nw�vuwvlUw erwrrw�rrdww(mi amumawmrwawrmmi <br />--- .... — ... ........ <br />...w...�.. ....... ..........._... <br />Required Prior to Submittal to Board <br />.._.__..... <br />BPW Attorney El Attorney Name __.. <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the Appropriate Item Type _... <br />Professional Services Agreement ❑ Contract <br />E] Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />Quote Opening <br />❑ Quote Award <br />EI 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 />Amount of <br />F1 <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 />Information <br />All Submissions <br />[❑ Proposal <br />Special Purchase, QPA <br />® Req. to Advertise <br />❑] Reject Bids/Quotes <br />PCA <br />I❑] Resolution <br />Ease./Encroach <br />N/A <br />............ <br />....Ye.............................................w w <br />s If Yes, Approved by Purchasing <br />�] No <br />❑ MBE Completed E-Verify Form Attached <br />[� WBE <br />2019 Demolitions, Phase I <br />119-035 <br />N/A <br />Base Bid <br />❑ Title Sheet <br />[� Yes <br />No <br />_................... ....... m ... ................. — <br />For <br />Increase $ <br />Decrease ($ <br />Increase <br />Decrease <br />Increase <br />Decrease <br />a—, <br />