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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/18/19 <br />Name Alicia Czarnecki Department �;n ilnee�r in <br />BPW Date 11/26/19 Phone Extension 5903 <br />MMMMMMIMpMdIdPoNNN MMMIIIMIIMIIMIIIIIIIMMMMMMMMM <br />...... Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney 0 Attorney Name <br />Purchasing <br />Check al Services Agreement e —ement r[� Contract <br />ract <br />❑I Open Market Contract Amendment/Addendum <br />❑ Bid Opening Bid Award <br />❑ Quote Opening Quote Award <br />Proposal Opening C/O & PCA No. <br />❑ Chg. Order, No. E] Traffic Control <br />Other: <br />Reomuird Information <br />All Submissions <br />U Proposal <br />Special Purchase, QPA <br />0 Req. to Advertise <br />Reject Bids/Quotes <br />[� PCA <br />Resolution <br />El Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Jones Petrie Rafinski�ioratmon <br />New Vendor <br />❑ Yes If Yes, Approved by Purchasing <br />❑ <br />No <br />MBE/WBE Contractor <br />❑] MBE Completed E-Verify Form Attached <br />Nos <br />Project Name <br />DylanDriveLi htin lmprovements <br />Project Number <br />119-047 <br />Funding Source <br />COIT <br />Account No. <br />404-0602-431.31-06 ...................... <br />Amount <br />_ ._..... .... _�. ---- _ ��.�.�.�.�......�....m <br />$f 7,085.00 <br />Terms of Contract <br />NTE �_............ ��.... ......_ w .....�.. �,e, <br />Purpose/Description <br />�....._�_- . _..... . -. ...... <br />Pre care construction documentsands ecial rovisions for the conversion o <br />cit -owned li is on D Ian and Parkland Drives to LED and the addition of <br />street li hts on Chet Waggoner Court. <br />Amount of <br />Increase $ <br />Decrease ($ )...... <br />Previous Amount <br />$ �.�.......... <br />�6 ���� <br />Increase % <br />Current Percent of Change: <br />Decrease_.%)..........................�.�.�............. <br />NewAmount <br />$........._.........�....�.._..�_�.............�.....�_a.__�._..�.�w�...._......... <br />Increase % <br />Total Percent of Change: <br />....... <br />Decrease ( /°) <br />Time Extension Amount: <br />New Completion Date: <br />