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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />16/19 <br />Date _� .w_ <br />Name Cara Grabowski Department: Public Works <br />BPW Date Phone Extension 5819 <br />WE GYNNO,WNWW4FfnMWOIEi m ll u'FPo#'�'IYe�IWYY MwMOhiwM0F9�IANNONNpOI A W,ii /Iimii�WY1NS <br />Required Prior to Submittal to Board <br />BPW Attorney <br />.._ �....� ....� w � _._ ...m._ � m.....__� ........ �wm�.. �.P �..�H, _ m ............ _ . �. <br />mey Z Attorney Name Clara McDaniels <br />Dept. Attorney EJ Attorney Name <br />_....m..m............. <br />.............w�w�w�...... m......�.....�.... <br />Purchasing El <br />Check the Awrotirlate Item Tvr)e — l eauired fiv All Submissions <br />u Professional Services Agreement L_J Contract <br />Open Market Contract 7 Amendment/Addendum <br />Bid Opening <br />E! Bid Award <br />❑ Quote Opening <br />El Quote Award <br />Proposal Opening <br />[ C/O & PCA No. <br />E Chg. Order, No. <br />❑ Traffic Control <br />F-1 Other: ALyreenierrt <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 />uired Information <br />" Proposal <br />Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheet <br />❑I, Reject Bids/Quotes <br />PCA <br />E] Resolution <br />Ease./Encroach <br />Neutron Holding- <br />0 Yes[:] If Yes, Approved by Purchasing <br />No <br />[J MBE Completed E-Verify Form Attached Yes <br />WBE No <br />Lime Bike Donation <br />Lime will donate 100 bikes to the City at no cost and train City <br />personnel to dismantle the bikes to remove any proprieta etc u%pment. <br />For ha n °xe Orders Oni ..... NY O4✓ `W _....... .._..... <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$..................... <br />...... ......................................o.... <br />Increase <br />/o <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />