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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/16/2019. �._...............__...� �............ <br />Name Michael Schmidt Department Citywide <br />BPW Date 9/24/19 Phone Extension 9977 <br />ReyxiNecl Pnor to Submittal to Board <br />BPW Attorney ® Attorney Name McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing Schmidt <br />Check theITAprote Item ] ymm ..1 <br />El Professional Services Agreement Contractm <br />❑ Open Market Contract El Amendment/Addendum <br />❑ Bid Opening Bid Award <br />[� Quote Opening Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />❑ Chg. Order, No. ❑ 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 />Purpose/Description <br />Amount of El <br />El <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Information <br />All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />�] Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE WBE Completed E-Verify Form Attached ❑ Nos <br />Re uest to Advertise City Uniform, Mat and Rag Bid <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date:.�.,.,ae__ <br />