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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date _September 6 2019 <br />Name Pam Mever Department DCI <br />BPW Date Se tember 10 2019 Phone Extension 5845 <br />uuummumrv��rur rr,anrni�avris ;aar� ,�� �...,�� ��.... ������ .k�r••., _.. ._�m,,�.dui,�ano:�sur�evc�a�er;�ro��wzmrov�n�.�.�.�n� a.�,-,�m�rz � u�u�u���Mmrrvm��a�rcnuer�rwv�u„Nrear rR,u�.� �-a��� <br />uired Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />__................. �........m ............................ <br />Dept. Attorney � Attorney Name Sandra Kennedy <br />Purchasin <br />Check the Appyopr i tt Item s^ li uired All Submissions <br />El w..._..Professional � ............... .........e...... .......e�...w_ -- <br />Services Agreement E] Contract <br />E] Open Market Contract ❑ Amendment/Addendum <br />Bid Opening Bid Award <br />❑ Quote Opening Quote Award <br />Proposal Opening E] C/O & PCA No. <br />("If' Order, No. Traffic Control <br />tl e': Sp <br />eeial LJse Exception <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 />j Proposal <br />❑j Special Purchase, QPA <br />j Req. to Advertise <br />E] Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />❑ Ease./Encroach <br />❑ Title Sheel <br />Area Board of /oning Aals <br />-------- <br />El Yes❑ If Yes, Approved by Purchasing <br />PK) <br />❑ MBE Completed E-Verify Form Attached Nos <br />❑ <br />WBE <br />Weather Amnesty site for 2019-2020 <br />For Change Orders Onl <br />Amount of <br />Decrease <br />E $ Increase -- ---- <br />------------- _...............- . ..................................... . . . . - ------- -_ _____ <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 />% <br />Decrease <br />( % <br />Increase—__.__,_,_,.�..........,% <br />Decrease <br />