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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date06/24/2019..._............��_�_���.......... ----- � . . �.�........�................. <br />Name Toy Villa <br />Department: ent. Engineering <br />e .... <br />BPW Date 07/09/2019 Phone Extension 5920 <br />IIIIIIIIIIIIIIItW,GIWbIfKN OEM OlC9 IflIMIIIIIIIIIIIIIIIWVIWV�IWV�IWWWIW'YllVIVI�I WR 111111166 9 mmmmIIIIIIIIIIIIIIIIIIIIIIIIWIWMI '@ <br />_ R�qt ired_Prior to Submittal to Board <br />BPW Attorney � ��� Attorney Name ...........�.__ . . ............... �...�....... <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the <br />L Professional Services Agreement L Contract <br />❑ Open Market Contract <br />[] Amendment/Addendum <br />E] Bid Opening <br />E] Bid Award <br />Quote Opening <br />Quote Award <br />F-1 Proposal Opening <br />n C/O & PCA No. <br />Chg. Order, No. <br />El Traffic Control <br />Other: <br />Company or Vendor Name The Robert H <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 />Jo)All Submissions <br />E] Proposal <br />"I Special Purchase, QPA <br />E] Req. to Advertise ❑ Title Sheet <br />Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />Yes" If Yes, Approved by Purchasing <br />No <br />❑❑ MBE Completed E-Verify Form Attached ❑❑ No <br />WBE <br />VPA Maintenance Storage Building <br />118-046R <br />Park Bond Series I <br />471.1138.452.42.01 <br />$388,984.00 <br />Project Closeout <br />........ --- w <br />For Clot Orders Only <br />mmmmm <br />El increase. .....�.: <br />Amount ._ � � ........... ..._ <br />t of Decrease <br />$ <br />❑ crease �$ ��.. � �� � ........_w...� ...�...._ .....r�_ .. <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 />Increase...............���...��..........�w <br />� ..�.. <br />�o <br />Decrease <br />( % <br />