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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/21/2019 <br />Name Loa Timmer Department DCI <br />BPW Date 12/10/2019 Phone Extension 5841 <br />19WIIIWIIIftf%b/: 1� i � Jmll� a IIVIONWWIVMY WIIIIIIIIIIIIIIIIIIIIIIIIWIVIV4Wi'YYI/ N1M I '�, fJririY, <br />w Rec��ti�y�,l Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Sandra Kennedy <br />PurchasingMichael Schmidt <br />...........................w__..............�...................�_.�. <br />..._. ..Check the Aroi i Item "1"ype Corr <br />El Professional Services Agreement ❑ Contract <br />Open Market Contract ® Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />Quote Opening E] Quote Award <br />0 Proposal Opening ❑ C/O & PCA No. <br />El Chg. Order, No. ❑ Traffic Control <br />I❑ 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 />of Innovation <br />All <br />Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />�] Reject Bids/Quotes <br />❑ PCA <br />E] Resolution <br />Ease./Encroach <br />Yes �� j If Yes, Approved by Purchasing <br />No <br />❑ Title Sheei <br />... _........ <br />For Ch !I .Orders �t m <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease <br />Previous Amount <br />$ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />.. ........... ...... m............. <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />%) <br />Time Extension Amount: <br />m.......... <br />New Completion Date: <br />