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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date October 14.2019 <br />Name Scott <br />Department Public <br />Works <br />BPW Date October 22 2019 Phone Extension 9245 <br />wrvm flffluuuuuuM1MMMmm wwuamwmmmm%uw..... orr�m®rwm�^„mmm�, uuuuuuuuuuuuuuuuuuuuuuuuuumumumummmmmmmuwi m w mr mw. wwum� w,renmm <br />.qq!jireetl Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing El Michael S-W_...... <br />chmidt <br />Check the AppLopfia,te Item T1 e - i <br />❑ Professional Services Agreement El Contract <br />F-1 Open Market Contract ❑ Amendment/Addendum <br />E] Bid Opening ❑ Bid Award <br />Quote Opening El Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />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 />Information <br />All Submissions <br />❑ Proposal <br />E] Special Purchase, QPA <br />® Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />[:] PCA <br />❑ Resolution <br />O Ease./Encroach <br />........ ..............._ ...�6 �...................._ __. _� <br />Yes❑ If Yes, Approved by Purchasing <br />[f No <br />DMBE Completed E-Verify Form Attached Nos <br />WBE <br />Community Crossings Round 2 <br />119-065 <br />LRSA <br />., 25�1-0608-431.31-06....._�........_�_.........�..-..._.—...................................___ ...�............-�-....._ ,,._�..... <br />1" Ad: November . 8 2019 <br />........... <br />2°d Ad: November 15 2019 <br />Fay Chtie�Ord�rs Cw,it� � �':��. <br />_--.-.._- ❑ Increase <br />Amount of ❑ Decrease ($ ) _..-.e.........................-�.......... _--........��.. <br />Previous Amount $ <br />r.� i ; p ." i U;" 1'�7 4- <br />Current Percent of Change:. <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />% <br />Decrease <br />% <br />Increase <br />/o <br />Decrease <br />(' % <br />