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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 7, 2019 <br />Department Public <br />Name Kim Thompson ........ Works <br />.... . . . . . ...... <br />BPW Date November 26, 2019 Phone Extension 5969 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara MeDaniels <br />Dept. Attorney Attorney Name Clara McDartiels <br />Purchasing <br />Check the <br />ItemTyp _ S - Requiredfi)r All Submissions <br />. . ..... ..... - ----- <br />D Professional Services Agreement E] Contract <br />E] Open Market Contract <br />El Amendment/Addendum <br />Bid Opening <br />Bid Award <br />Quote Opening <br />❑ Quote Award <br />E] Proposal Opening <br />FIC/O & PCA No. <br />n Chg. Order, No. <br />El Traffic Control <br />El 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 />Required Information <br />Proposal <br />J_J Special Purchase, QPA <br />E] Req. to Advertise <br />EJ Reject Bids/Quotes <br />E] PCA <br />E Resolution <br />Ease./Encroach <br />-------- - --------- - - - - - -- - <br />L_J Yes L_J If Yes, Approved by Purchasing <br />F-1 No <br />0 Title Sheei <br />FIMBE WBE Completed E-Verify Form Attached Nos <br />[:] <br />. ...... . ..... . ..... . . ..... ... . . ...... <br />. ..... . For.. Change Orders On]-y"11111 <br />Amount of Increase ......... <br />6. <br />Decrease <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease <br />New Amount <br />Increase % <br />Total Percent of Change: Decrease (, %) <br />Time Extension Amount: <br />New Completion Date: <br />..... — — ----- <br />