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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/16/2019 <br />Department Public <br />Name Zach Hurst Works / E�� i;neerin <br />BPW Date 09/241201.9 Phone Extension 3057 <br />mmIIIIIIIIIIIIIIIIWII , . XRAMIII4W�IimmilIIIIIu �NNnlnl � BB�IDfD/HAMTMIMIIIIIIIImIImIIIIIIIIIIIIIIImmmNNttINN <br />l e Umircd mPrior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney <br />Purchasing <br />] Attorney Name <br />Check the A't <br />H Professional Services Agreement LJ Contract <br />Required lbr All Submissions <br />❑] Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />F Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />Traffic Control <br />F-1 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 />Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />® Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Yes If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ No <br />WBE <br />Kizer Mansion Window Repair <br />119-024 <br />g West Washington TIF....� <br />422-1050-460-42.02 <br />See attached memo. <br />For .�h� ge Orders On] �...w <br />Amount of El <br />increase $ <br />Decrease <br />Previous Amount <br />$ <br />Increase <br />Current Percent of Change: <br />Decrease <br />%) .._.....�....... _____.� ..........�.�.�.......... <br />New Amount <br />$ _ <br />............... <br />Increase <br />ew o ........ � ......�w ....._ ... <br />/o <br />Total Percent of Change: <br />m. <br />Decrease <br />................—......— ...,.................. ..... <br />%) <br />Time Extension Amount: <br />New Completion Date: <br />