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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8..3....1..9.......................m ..... .�.. <br />Name Scott Kree er Department: Engineering <br />BPW Date 9/10/19 Phone Extension 9245 <br />io�wr�u muor�ur�r�r�mn�anuuuuuuuuuuuuuuuuuu!wuuwiwmumuwmuummmmmuuuur!��mrcrru¢,wtiawmem�uwvievr�.rre �,�,�,.k�..,,� r� 000morcmom00000000mmmomm�mm�m�ommw.urvmm�rmiwrw.w.um�rd+� grow nmwm <br />�,.�.... _._._.._ __......._._ ._ <br />Required Prior to Submittal to Board <br />BPW Attorney Z Attorney Name Clara McDaniels <br />Dept. Attorney ❑l Attorney Name <br />Purchasing ❑ Michael Schmidt <br />Appro riate ItemTTe - Re uir <br />�,._.-.— Check the,_,__ ..__. <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />E Bid Opening E] Bid Award <br />EJ Quote Opening Quote Award <br />Proposal Opening ❑I C/O & PCA No. <br />❑ Chg. Order, No. ❑' Traffic Control <br />F� 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 />Information <br />for All Submissions <br />[❑ Proposal _�.._.__.._ _ ._�...... <br />[J Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />® Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />F-1 Ease./Encroach <br />Lj Yes L If Yes, Approved by Purchasing <br />❑ No <br />MBE Completed E-Verify Form Attached Yes <br />WBE � No <br />East Bank Tr <br />ail Storm Repairs <br />118-306 <br />_�,..,�u . , .�...�.�...,_.......... <br />Liability.................................... <br />Insurance Fund <br />226-0419-672.42-03 <br />uote amounts exceed the $150 04� quote limit and the project budget. <br />For Chan e Orders nt <br />Increase <br />Amount of $ <br />El Decrease ($ ) <br />Previous Amount $ <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 />0 Days <br />