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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/11/19 <br />Name Therese Doraaa/Alicia Czartiecki Department En2ineeria <br />BPW Date 07/ 3/ 19 Phone Extension 5903 <br />t ��1f®l2HP IWNWWW#','MINIIMI, .. PYP�A'd/lCI1W5MRlHhWNf'NflFP,/MN�W���W�I''MMM.N�V�V�� •..... M�mmafflru i�rmrtr�rawr��mwra�: ��rrms�uri ummuuoi�� um„�-� <br />R� r.� tad Pnor to Submittal to <br />_.. �. mm <br />'q Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney E] Attorney Name <br />Purchasing <br />Check the Appropriate Item Type - <br />LJ Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />Quote Opening <br />❑ Quote Award <br />Proposal Opening <br />F-1 <br />C/O & PCA No. <br />F-1 Chg. Order, No. <br />F-I <br />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 />uired Information <br />For Chartae Orders On <br />Amountof <br />increase ................................................�.�.�.�.�..........�._._ <br />Decrease <br />Previous Amount <br />$ <br />............ <br />Increase............................ww.........._. <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( % <br />Time Extension Amount: <br />New Completion Date: <br />All Submissions <br />J Proposal <br />Special Purchase, QPA <br />® Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />1 rd Of I <br />❑ Title Sheei <br />