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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/2/2019 <br />Name Daniel Parker Department Admin & Finance <br />BPW Date 12/10/2019 Phone Extension 9822 <br />mmmmmmmmmmm <br />... _................. <br />1 <br />Required Prior to Submittal to Board <br />BPW Attorney Z Attorney Name Clara Daniels <br />Dept. Attorney Z Attorney Name Elliot Anderson <br />_._...�._ .. ._....... _._._._._._.........__..... ........ <br />PurchasingZ Michael Schmidt <br />Check the A p m rile Item "1 <br />ZProfessional Services Agreement Contract <br />0 Open Market Contract E] Amendment/Addendum <br />0 Bid Opening Bid Award <br />0 Quote Opening Quote Award <br />Proposal OpeningIT C/O & PCA No. <br />f Chg. Order, No. Traffic Control <br />❑ 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 />Bruce Sn <br />Yes <br />® No <br />EJ MBE <br />❑I WBE <br />ired Information <br />(Ifi, ^ All Submissions <br />E Proposal <br />Special Purchase, QPA <br />E] Req. to Advertise ❑ Title Sheet <br />�❑ Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />If Yes, Approved by Purchasing <br />Completed E-Verify Form Attached ❑ Yes <br />❑ No <br />For Chanue Orders Onl <br />Amount of El Increase $ ........... .......... <br />❑ Decrease �.. .�....... �r��� <br />Previous Amount $ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />% <br />Decrease <br />..............m........ % <br />Increase <br />% <br />_..................................................... <br />Decrease <br />( % <br />