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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />10/29/2019 <br />Villa <br />Department Public <br />Works <br />BPW Date 11/12/2019 Phone Extension 5920 <br />-.._... ____ _W ..... ..... <br />_ . <br />Required Prior to Submittal to Board <br />..... __.... <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the �a at�Item 1"�)e � �`c�,ayi <br />Professional Services Agreement E] Contract <br />[� Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening Bid Award <br />❑ Quote Opening Quote Award <br />❑ Proposal Opening C/O & PCA No. <br />❑j Chg. Order, No. R, 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 />uired Information <br />All Submissions <br />LJ Proposal <br />E] Special Purchase, QPA <br />E] Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />She Construction C'onpap , Inc. <br />Yes ❑ If Yes, Approved by Purchasing <br />Z No <br />[:] MBE Completed E-Verify Form Attached <br />F ] WBE <br />East Race Boat Launch Slope Repairs <br />118-305B <br />Streets &ITAlleyswwm <br />226-0419-672.42-03 <br />Project Closeout <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />...... ITIT For C .ing Orders Q91y <br />........... ..-............. <br />Amount of Increase $ <br />Decrease ) <br />�_...........�..._............................ <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease._ ................ % <br />New Amount $ <br />Increase % <br />........... <br />Total Percent of Change: Decrease %) mITITITITmmmmmmITITITITIT m <br />Time Extension Amount: <br />........... ._. _ <br />New Completion Date: <br />