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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />09/16/19 <br />Alicia Czarnecki <br />Department 1,'g ineerin <br />BPW Date 09/24/19 Phone Extension 5903 <br />iii ii ii ii mm <br />.... _ _.. <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the Appropriate <br />Item I" r 1 <br />❑, <br />Professional Services Agreement <br />❑ Contract <br />El <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />0 Bid Award <br />❑] Quote Opening <br />® Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />Chg. Order, No. <br />Traffic Control <br />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 />Amount of <br />Previous Amount <br />The <br />El Increase <br />El Decrease <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Information <br />All Submissions <br />H Proposal <br />E Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />0 PCA <br />Resolution <br />Ease./Encroach <br />lete installation of handrails at the Morris Theater. <br />Increase % <br />Decrease ( % <br />Increase % <br />Decrease ( % <br />❑ Title Sheet <br />