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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 1, 2019 <br />Name Kara Bo <br />BPW Date October 8 <br />Department: Engineering <br />Phone Extension 5933 <br />.............. <br />Re wired Prior to Submittal to Board <br />. ......._-......... _._...... _. _ ........ � __....-... <br />BPW Attorney Z Attorney Name Clara 1'" cl?anicls <br />Dept. Attorney Attorney Name <br />Purchasing Michael Schmidt <br />m om mmITITmm m�mCheck the Appropriate Item Type - Re u rE <br />Z Professional Services Agreement F-1 Contract <br />Open Market Contract Amendment/Addendum <br />Bid Opening Bid Award <br />E] Quote Opening E] Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. ❑ Traffic Control <br />Other: <br />..............__- _._.__._—___... ... ...... .... __... ...... W _...._.._.. „ .. <br />Required Information <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 />for All Submissions <br />❑ Proposal <br />Special Purchase, QPA <br />] Req. to Advertise ❑ Title Sheet <br />Reject Bids/Quotes <br />] PCA <br />Resolution <br />Ease./Encroach <br />Baker "fill..__ ..... .... <br />Yes If Yes, Approved by Purchasing <br />No <br />0 MBE Completed E-Verify Form Attached ❑ Nos <br />Municipal Advisory for LICAP <br />m.... .. <br />119-023 <br />Eng.�......------g----- �w� � w � ,......... �..................................................�.�.._..................��.................................... <br />ineerin Professional Services <br />101-0602-431.31-06 <br />. ev <br />Municipal A Mu Advisory services related to the development of a Low -Income <br />........... <br />Customer Assistance Program for sewer rate credit. <br />x FITe Orders Onlyhat <br />... Amount of Decrease <br />crews <br />$ <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount:. <br />New Completion Date: <br />Increase _ % <br />Decrease ( % <br />Increase % <br />Decrease (..................% <br />