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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Au ust 20 2019 <br />Name Alicia Czarnecki Department Ensineerins <br />BPW Date Au ust 27 2019 Phone Extension 5903 <br />��. IIT.WIfWM�M�'MP�IP'PP'PIPIM1'iMM'MMIMIWVIVI IVWV�WW�.LL4WIW91N.@4WW.WM^4NNfYf01�M�Jffi/Nd§lM�MO�MO <br />Rtl Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney <br />Purchasing <br />❑ Attorney Name <br />10 <br />Professional Services Agreement (❑ Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening R Bid Award <br />❑ Quote Opening El Quote Award <br />�] Proposal Opening R C/O & PCA No. <br />Chg. Order, No. ❑ Traffic Control <br />El Other: <br />Reauired Informati <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 />l Submissions <br />LJ Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />11 <br />u' Title Sheet <br />-❑ Yes❑ If Yes, Approved by PurchasingWWWWWWWWW—' mm <br />No <br />E] MBE MBE Completed E-Verify Form Attached Nos <br />Fire Stations 3 & 6 Renovations <br />118-047 <br />FIRE CAPITAL IMPROVEMENTS / BUILDING IMPROVEMENT <br />...................................... _.........................................._..._.............�. <br />287-0902-422.42-02 <br />South Bend Fire Stations 3 and 6 Renovations <br />�] 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 />% <br />Decrease <br />_...........�. _w <br />�w <br />Increase <br />_ ............. 6 <br />% <br />Decrease <br />( %) <br />