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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 62 2019 <br />........................._................._�_� <br />Name Charlotte Brach��_�_..............�....._—. <br />Department Engineering <br />BPW Date August 132019 Phone Extension 9246 <br />Required Prior to Submittal to Boar . . <br />BPW Attorney Attorney Name <br />Dept. Attorney r-] Attorney Name <br />Purchasing <br />Check the A Eopa q Item T #c era <br />Professional Services Agreement � Contract <br />Open Market Contract EJ Amendment/Addendum <br />] Bid Opening [] Bid Award <br />F] Quote Opening Quote Award <br />Proposal Opening C/O & PCA No. <br />❑ Chg. Order, No. ] Traffic Control <br />E] 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 />Amount of <br />Previous Amount <br />LJ Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise <br />E] Reject Bids/Quotes <br />❑] PCA <br />Resolution <br />Ease./Encroach <br />® Title Sheet <br />N/A <br />❑] Yes ❑ If Yes, Approved by Purchasing <br />�] No <br />MBE Completed E-Verify Form Attached ❑ No <br />WBE <br />._ wRoof Repair <br />VestedInterest Building <br />.... ��.�..._...........................................-____� �� <br />119-049 <br />RWDA TIF ,,,,,_..�. �........._...P_ <br />324-1050 460-42.02 <br />�.._........ ..........�wu �.�.....�..... <br />Base Bid r) ll <br />C] Increase $ <br />Decrease <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease .................. -% <br />Increase _ % <br />Decrease ( % <br />