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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: Se tember 17, 2019 <br />Name: Charlotte Brach <br />Department: Public Works <br />BPW Date: Se tember 24, 2019 Phone Extension: 9246 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />_.. Check the Appropriate Item 1"y Requ, <br />❑ Professional Services Agreement ❑ Contract <br />Open Market Contract E Amendment/Addendum <br />❑ Bid Opening 0 Bid Award <br />❑ Quote Opening Quote Award <br />❑ Proposal Opening ❑ C/O & PCA No. <br />0 Chg. Order, No. ® Traffic Control <br />E] 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 />...... <br />H Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />F-1 Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE ❑ No <br />1145 Napoleon <br />TR18-019 <br />Install "15 Minute Parking Loading Zone" Signs for two parking spots at <br />1145 Napoleon <br />......... ..._. <br />For Change wOrders Onl <br />Amount of <br />Increase <br />Decrease $ ) <br />Previous Amount <br />$ <br />Increase <br />/o <br />�..._.........._ ......_.. �.w. <br />Current Percent of Change: <br />Decrease <br />%) <br />New Amount <br />$ m� .� ..m.......................�we <br />m...._ �_ � ....... ................ m .......... <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />0 <br />/o <br />Time Extension Amount: <br />....._....W ._. <br />New Completion Date: <br />