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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/30/19 <br />Name Ken Smith Department Utilities <br />BPW Date 10/8/19 Phone Extension 5787 <br />��w»nm mwi �ru�,uarmm iva;a;m minim m www�mirv,���ue <br />..._.. Rc �a�red Prior to Submittal to Board <br />�_ __.. .. ........ , __ ...�._..._...��........tta _ . .. ...... _W.... <br />BPW Attorney ZAttorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ® Michael Schmidt <br />Check the Apt <br />E] Professional Services Agreement <br />Open Market Contract <br />Bid Opening <br />F] Quote Opening <br />❑ Proposal Opening <br />Chg. Order, No. <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 />_ _Item Ty�p Rey <br />y <br />Contract <br />Amendment/Addendum <br />❑ Bid Award <br />® Quote Award <br />[] C/O & PCA No. <br />Traffic Control <br />Information <br />All Submissions <br />Proposal <br />Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheei <br />FJ Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />Milestone Fence LLC <br />Yes If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE No <br />Northwest Fence Replacement <br />Wastewater & Sewer O&M <br />. . ..........- 41 0630793 36..05.........................�.�.�..... <br />$39,900.00 <br />For Clan_ge Orders Only. <br />Amount of <br />Increase $ <br />m. <br />❑ <br />Decrease ($ <br />) <br />Previous Amount <br />$ <br />Increase <br />Current Percent of Change: <br />Decrease <br />/o) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />............... _............. <br />