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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/09/19 <br />Name Alicia Czarnecki Department Engineering <br />BPW Date 10/22/19 Phone Extension 5903 <br />!ommuwimwwwwwuwiuiuiuwimmawww�.ra mnwvrnnara �mimiNuuiuiwuuuuuuwiu �iwiuwiuioioi�iM uuuuuwuuWmoM. <br />_ bmitt <br />�..__........ --Required, Prior to Su al to Board�.. <br />BPW Attorney Attorney Name <br />Dept. Attorney <br />Purchasing <br />Check the <br />Professional Services Agreement <br />Open Market Contract <br />Bid Opening <br />Quote Opening <br />❑, Proposal Opening <br />Chg. Order, No. <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 />Amount of L—' <br />E1 <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 />Attorney Name <br />le Item Type -- <br />Contract <br />El Amendment/Addendum <br />E! Bid Award <br />0 Quote Award <br />El C/O & PCA No. <br />I❑ Traffic Control <br />Information <br />All Submissions <br />Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise <br />❑ Reject Bids/Quotes <br />0 PCA <br />Resolution <br />Ease./Encroach <br />® Title Sheet <br />s ❑ If Yes, Approved by Purchasing <br />No <br />E] MBE Completed E-Verify Form Attached Yes <br />Q WBE No <br />Morris Theater Em <br />ergency Plaster Work <br />VPA Morris _ <br />226-0419-672.36-01 <br />Restoration „work of the plaster frieze at the perimeter of four domes at <br />Morris Perfon-ring Arts Center. _ITIT� <br />. ForC�;'C)rders _ .._ <br />Increase $ <br />�..._.. �� A,... - <br />Decrease <br />Increase %'' <br />Decrease ( /o ^� <br />�. �.. <br />Increase % <br />Decrease /o)t �- <.,,.., <br />