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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/30/2019 <br />Name Tov Villa <br />Department Public <br />Works <br />BPW Date 10/08/2019 Phone Extension 5920 <br />.. ........................ <br />Re <br />PriortoSubmittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney F-1 Attorney Name <br />Purchasing (❑ <br />Check the ADoroiniat Item I'voc — <br />❑ Professional Services Agreement Contract <br />Open Market Contract p <br />Amendment/Addendum <br />E] <br />Bid Opening <br />� <br />Bid Award <br />0 Quote Opening <br />[ <br />Quote Award <br />❑ Proposal Opening <br />F� <br />C/O & PCA No. <br />Chg. Order, No. <br />❑ 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 />uired Information <br />All Submissions <br />--------------------- <br />Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />Burkhart Si wS sten s mm m <br />❑ Ycs[] If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑❑ No <br />� <br />WBE <br />.Centnry...Center Exterior Sign _................ m�,..........�.�...............�.�__ n. <br />118-035B <br />Hotel Motel <br />73 04.42010.000.0099 <br />$152,030.00 <br />Project Closeout. <br />__ ..... ...... ._....__ .._ <br />For � l��t g Orders 0� <br />Amount of ❑ Increase $��� <br />❑ Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />( mmmmmm <br />New Amount <br />$ <br />_._....... <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />% <br />Time Extension Amount: <br />New Completion Date: <br />