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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 18, 2019 <br />Name Charlotte Brach <br />Department Public <br />Works <br />BPW Date June 25 2019 Phone Extension 9246 <br />Re' Ulred PriortoSubmittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check theAppropriate Item Type <br />Professional Services Agreement [:] Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />Ej <br />Quote Opening ❑ Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />❑ <br />Chg. Order, No. ® 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 />All Submissions <br />L Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />m...� �.. .�.............. ��.�. ......... <br />Yes[:] If Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached FI Yes <br />❑ WBE ❑ No <br />Success Academv S1Qnaize <br />TR19-044A <br />Establish a school zone speed limit at Success Academy, add end school zor <br />signs and remove existing speed limit signs within the school zone. <br />.............. .._----- <br />For h ngc Orders Only <br />Amount of � <br />Increase <br />........._ _ .....� ....W..»_ <br />Decrease $... � <br />Previous Amount <br />$ ........... <br />.... .... ...... ... <br />.m_. <br />Increas. <br />e <br />% <br />Current Percent of Change: <br />e: <br />Decrease <br />%) <br />New Amount <br />$ <br />Increase <br />/o <br />Total Percent of Change: <br />Decrease <br />%) <br />Time Extension Amount: <br />New Completion Date: <br />