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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/10/19 <br />Name Alicia Czarnecki Department Engineering <br />BPW Date 10/22/19 Phone Extension 5903 <br />M MM <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />I Professional Services Agreement L Contract <br />El Open Market Contract ❑ Amendment/Addendum <br />El Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />EJ Chg. Order, No. <br />F-1 Traffic Control <br />F-1 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 />LJ Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise ® Title Sheet <br />Reject Bids/Quotes <br />PCA <br />El Resolution <br />Ease./Encroach <br />YesU If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑ No <br />Pinhook Park Site Improvements <br />118-077A <br />VPA Capital <br />�._ ................ <br />416.0404.453.36.01 <br />Construction of site improvements at Pinhook Park. <br />El increase <br />Amount of Decrease $ .. . .. �a ... <br />g��,��� Flu �w�.� <br />Previous Amount $ <br />......... ........ <br />y p . <br />I _. <br />u �Y" i B CqI�{y <br />Increase � <br />Current Percent of Change: Decrease % <br />New Amount $ ... <br />Increase % m° <br />Total Percent of Change: Decrease ( /o... <br />Time Extension Amount: <br />.�.. .......... __...._._. ._.... <br />. <br />New Completion Date: <br />