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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7/16/19 <br />Name Kelly Department: Public Works Solid Waste <br />Smith <br />BPW Date 7/23/19 Phone Extension 5795 <br />11111mAwAu. aar w rc�m NWIrHWHIv ��.•.... �..., ups r,� ,u m�eeruerww w ,r.....: RzMMMM15Mm1W=M.�— <br />�.... 1 o Board le x�c Prior to Submittal t .......... ___....... ._ <br />BPW Attorney Attorney Name Clara McDa iels <br />Dept. Attorney Attorney Name <br />Purchasing ® Michael Schmidt <br />..........__..w.._ _............... _. <br />Check the Appropriate Item Tie - Reuir <br />Professional:..... .... <br />Services Agreement ❑Contract <br />Fj Open Market Contract 7 Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />❑ Quote Opening ❑ Quote Award <br />E] Proposal Opening ❑ C/O & PCA No. <br />0 Chg. Order, No. ❑ Traffic Control <br />F-1 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 />for All Submissions <br />Proposal <br />[l Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheet <br />Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />F-1 Ease./Encroach <br />Baker Municip.al....Advisors�..............aLLC..........�.�.....�........ <br />Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached <br />❑ WBE <br />2019 Solid Waste Rate Studv <br />❑ Yes <br />® No <br />Solid Waste Budget Other O perms Supplies <br />610-0610-791.22-24 <br />Not to exceed Fifteen Dollars ($15,000) <br />........ - _ .m ...W- _�_� .... .. ...... <br />When stLJdv is comleted <br />c$ <br />Amount of ❑ Increase <br />❑Decrease ($ ) <br />__....� ..- .....-...... . <br />Previous Amount $ <br />Increase % <br />.. o................ <br />Current Percent of Change: Decrease ( /o) <br />-� �... — _�_�_..................._�_�m...........................—........... _..... �. <br />New Amount $_ <br />Increase......................................................................................%.............................................................................................-... <br />_. <br />Total Percent of Change: Decrease %mmm <br />Time Extension Amount: <br />New Completion Date: <br />