Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />07/05/2019 <br />Tov Villa <br />Department: Engineering <br />BPW Date 07/23/2019 Phone Extension 5920 <br />wrwn �rrv� mioimom�rtwm.u^�iti vmmm.?r1rkry�Otrnvmnc.W.rra �a„a,a aumrirr..��.�,..•m...m......,,.,,uaoouxwmiowuvw�,�aan��rMM� <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney 0 Attorney Name <br />Purchasing <br />Check the Af_Eq fate Item I pe mml mrtxr <br />6 —.... <br />❑ Professional Services Agreement ❑ Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />E] Bid Opening El Bid Award <br />Quote Opening 0 Quote Award <br />* Proposal Opening F-1 C/O & PCA No.. <br />* Chg. Order, No. El Traffic Control <br />Other: <br />w _. f to ui d Information <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 />A Submissions.........� <br />Proposal <br />L j Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />Walsh....& Kell.'z��ln...................................................................................................................�.�.�.. ................... _..m.,.�. <br />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached N s <br />Mc�inl 'y WlLle and Freemont Park Improvements Division B <br />.._ ........ �.� . <br />118-072 <br />LRSA and VPA <br />251.0608.431.42.96 1201.1101.452.36.01 <br />$245920.00 --- _-__--------------- <br />rgject,,Qlgseout <br />For ha -OrdersOnly <br />Amount of _______________ ... <br />Increase $ ............. __ <br />0 Decrease ($ ) <br />-- .....__........ .....---- <br />Previous Amount $ <br />Increase % <br />................_.__...,.m......... ..... <br />........................... <br />Current Percent of Change: Decrease ( _ %°) <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease %) <br />Time Extension Amount:. <br />New Completion Date: <br />