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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />11 /04/2019 <br />Amanda Pietsch <br />Department DCI <br />BPW Date 11/12/2019 Phone Extension 9330 <br />¢ �w� ruaum .waw=v=wwwwwwwwwwwwwwwww 11111uu=0�rr rr��r err ..,, .w,,,,�,. �,��»�*z nvry mmm ini o imr rWmmimmurrnuivreavrmN .�as�n!q ���mwwri�rnr e <br />....... ..._. � W.. _._ Required Prior to Submittal to Board <br />....... _ ................._._..� _.............. ........... <br />Legal ® Attorney Name Sandra Kennedy <br />greaterlthan one. year n length pertheCity cPurcha00 0 Polio <br />Controller ® r more and <br />Y l P g Y <br />Purchasing <br />Check the Appropriate Item Type — <br />Q Professional Services Agreement 0 Contract <br />r-1 Open Market Contract <br />® Amendment/Addendum <br />❑ Bid Opening <br />Bid Award <br />Quote Opening <br />Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />] Chg. Order, No. <br />❑ Traffic Control <br />F] 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 />or All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />E! Req. to Advertise <br />Reject Bids/Quotes <br />I PCA <br />F-1 Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />U. <br />. _ ... _.... <br />Yes ❑ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE F� No <br />Early Childhood Edon Provider CapacityGrantProgram <br />.mmucati....... <br />18J011 <br />.. W._ .. ....... .................. _ .._. <br />Redevelopment General Grants and Subsidies <br />433-1050-460.39-30 <br />.n.............._._ <br />N/A _. _... <br />o chan e m amount _ <br />..._........._ --- <br />.._............ <br />Extend termination date from 12/31/2019 to 06/30/2020 <br />For Cltn�� Orders Onl <br />Amount of <br />Increase $ <br />[� <br />Decrease$ <br />) <br />Previous Amount <br />$ <br />Increase <br />% <br />_....�... _.......... <br />Current Percent of Change: <br />Decrease <br />�. .....� .. _........_... <br />( %) <br />New Amount <br />$ _.........._........... <br />mm.__........ <br />. _._.. <br />Increase <br />�_.................. <br />% <br />Total Percent of Change: <br />Decrease <br />(mmmmmm <br />Time Extension Amount: <br />6 months <br />mmmmm -%) mmmmmm www aww <br />New Completion Date: <br />06/30/2020 <br />�.._. ....................... ......_.........._. <br />