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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/1/2019 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 9/24/19 Phone Extension 5998 <br />� r�mrr�uuuuuuuuuuumm � nn mmmma�mw� <br />wu��w!mmmmmmmmmuim�w�wm�ore; <br />Required aired Prior to Submittal to Board <br />,,._ ...... _.. _ ...._..................... <br />_..-....... : <br />BPW Attorney Attorney Name Clan*a McDaniels <br />Dept. Attorney El Attorney Name <br />Purchasing <br />... ............... <br />Check the Appropriate Item TvDe — `ecndry <br />L_J Professional Services Agreement H Contract <br />Open Market Contract Amendment/Addendum <br />E] <br />Bid Opening Bid Award <br />Quote Opening ® Quote Award <br />[] <br />Proposal Opening ❑ C/O & PCA No. <br />❑ <br />Chg. Order, No. Traffic Control <br />F� 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 />All Submissions <br />LI Proposal <br />Special Purchase, QPA <br />E] Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />E] Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />M & V Pro Services„ Inc. <br />❑Yes If Yes, Approved �.._ �m........�____��.._ �. .mm..... .._W....N <br />, �mmmmmmmmby Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑ No <br />_ lais Royale Interior Painting <br />9-055R <br />Historic Preservation <br />450-0405-453.36-01 <br />LumpSum............�.............................. <br />Interior—p r tirl_ in the Palais Royale Entry. <br />__ __.. <br />For Ch e_Orders Only <br />Amount of El Increase <br />Decrease �$ ) <br />Previous Amount $ <br />Increase /o <br />Current Percent of Change: Decrease %) <br />New Amount $ <br />Increase /o <br />Total Percent of Change: Decrease (ITmmmmmmmmmmmmmmmm%) <br />Time Extension Amount: <br />New Completion Date: <br />