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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 20, 2019. <br />Department Public <br />Name Charlotte Brach Works <br />BPW Date August 2 2019 Phone Extension 9246 <br />.. �aNN <br />tiitWe Prior to Submittal to Board <br />__ .... <br />BPW Attorney Attorney Name <br />Dept. Attorney [—] Attorney Name <br />Purchasing D <br />Professional Services Agreement Contract <br />1 <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />Quote Opening ❑ Quote Award <br />Proposal Opening ❑ C/O & PCA No, <br />Chg. Order, No. ® Traffic Control <br />7 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 />111 Submissions <br />......---- <br />�' Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />�] Reject Bids/Quotes <br />PCA <br />El Resolution <br />Ease./Encroach <br />0 Yes❑ If Yes, Approved by Purchasing <br />No <br />E] MBE <br />E] WBE Completed E-Verify Form Attached ❑ Nos <br />Twyckenham &wMishawaka Ave <br />TR 19-041 <br />Revise No Turn on Red time to end at 5pm instead of 4pm <br />Amount of F] <br />Increase <br />Decrease �$..�......! <br />Previous Amount <br />$ <br />...........................66 <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />_.. _... w_— ..............—. <br />New Amount <br />$_ wwwwwwwwwww <br />..... <br />Increase <br />e <br />._�����m.....- ..-----�----- <br />% <br />Total Percent of Change: <br />Decrease <br />(�ww . %) ----- <br />Time Extension Amount: <br />New Completion Date: <br />