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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/18/19 <br />Name ]Dina Thom son Department Utilities <br />BPW Date 6/25/19 Phone Extension 5969 <br />�.�._............... _........... ..........�..__ <br />1.equire_ rior to Submittal to Board <br />mmm <br />BPW Attorney Attorney Name Clai-°a McDaniel" <br />Dept. Attorney ❑I Attorney Name <br />Purchasing ❑ <br />Check the <br />U Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />Proposal Opening <br />Chg. Order, No. <br />Other: Rules <br />:te Item "I e <br />Contract <br />[-] Amendment/Addendum <br />E] Bid Award <br />Quote Award <br />�j C/O & PCA No. <br />] Traffic Control <br />red. or All Submissions <br />Recauired Information <br />❑ Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheel <br />Reject Bids/Quotes <br />[:] PCA <br />Resolution <br />Ease./Encroach <br />Company or Vendor Name <br />N/A <br />Yes[] If Yes ApprovedPurchasing <br />❑ pp y <br />New Vendor <br />❑ 0 <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached Nos <br />Project Name <br />Project Number <br />Funding Source <br />N/A <br />Account No. <br />Amount <br />Terms of Contract <br />m.............................................................ww........... _ _ _ �.......... �.�...........................�.�.�.�................_ � _..............._ <br />Purpose/Description <br />South Bend Municipal <br />Utilities Rules and Regs revisionto address HB1347 changes to owner/ten <br />accounts <br />Chita e Orders Oral <br />Amount of ❑ Increase $ <br />Decrease <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ <br />Increase^ <br />° �o <br />Total Percent of Change: <br />Decrease <br />(mm......% <br />Time Extension Amount: <br />New Completion Date: <br />