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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 28. 2019 <br />Name Scott <br />Department Public <br />Works <br />BPW Date July 9, 2019 Phone Extension 9245 <br />!'�'X'Jfn1d1lq�fY41YYU///fN?�F'NlgMVNN/tl��(ryi � WWriIIN➢ UAHYdHHt�B/ mllifiMWdIINMfNI�'11�II�ININVWWWWWVIVIW�WIWINVW�'��I �� IJl2AIiW, IM, <br />Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name Clara McDaniels <br />Dept. Attorney E] Attorney Name <br />Purchasing Michael Schmidt <br />Check the Appropriate Item Type — <br />F] Professional Services Agreement 1:1 Contract <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />n Bid Award <br />Quote Opening <br />] Quote Award <br />Proposal Opening <br />E] C/O & PCA No. <br />Chg. Order, No. <br />® Traffic Control: <br />Residential Handicap <br />Parkin <br />I Othermmm <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 />All Submissions <br />LJ Proposal <br />Ej Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />�] PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />L ] YesU If Yes, Approved by Purchasing <br />❑ No <br />MBE Completed E-Verify Form Attached N s <br />WBE <br />. 1648 W In........rana Avenue ..Residential Handicap Parking —. <br />Recommend Approval „ <br />For ChangeOrdersOnly <br />Amount of ❑ Increase $ <br />❑ 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 />R <br />Increase % <br />Decrease ( % <br />Increase % <br />................................................. <br />Decrease ( % <br />