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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/2019 <br />Name Becca <br />Department Public <br />Works <br />BPW Date 10/22/19 Phone Extension 5998 <br />omommomumammmmmmamrrawmararm remmronmm <br />quir d'Prior to Submittal to Board <br />_. _.._.........._.. ... <br />BPW At m...____ ..... _ _...... <br />torney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the AppropriaCe Item Thew �r t� <br />Professional Services Agreement ❑I Contract <br />El Open Market Contract R Amendment/Addendum <br />Bid Opening E] Bid Award <br />E Quote Opening El Quote Award <br />[:1 Proposal Opening R C/O & PCA No. <br />El 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 />All <br />L Proposal <br />❑ Special Purchase, QPA <br />E] Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />DLZ hidiana, LLC <br />.... <br />Yes[:] If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached <br />WBE <br />Cleveland South Well Field Bulk Fluoride Tank I <br />118-021B <br />.�.�.............................wwww ,,,.�......_. .... <br />Riverwest TIF <br />324-1050-460.42 02 <br />$8,800....0 <br />Lump Sum <br />❑ Title Sheet <br />Yes <br />❑ No <br />acement <br />The preparation ofconstruction documents for rernoyina and re laciri , the <br />existing bulk fluoride tanks. <br />.�m ...... ..--... <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />_................ _._.. __ .._. <br />El <br />Decrease <br />Previous Amount <br />$ <br />m �_... ....._W...__w� aa..._._..._.....N.........�.._ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />m__ _ ................. .......... <br />( %o)wwwwww <br />New Amount <br />$ .. ............................ <br />w ............ ............... <br />Increase <br />�._............... .._........... <br />% <br />Total Percent of Change: <br />Decrease <br />/o <br />Time Extension Amount: <br />New Completion Date: <br />................... <br />_.�._�_ w.........�..�.�...�.�..............�_ <br />