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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1 1211 _.... _. _... _ .... — _ <br />Name Alicia Czarneeki/Ra er Nawrot . .......�. <br />Department <br />BPW Date 12/10119 Phone Extension 5903 <br />'� �,,�_�____... _�e tired Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name _. <br />Dept. Attorney El Attorney Name—.�...w.�.,��..m__�..�.�.��.... �...w�-.. <br />Purchasing <br />Check the AN riate Item T e l e <br />Professional Services Agreement Contract <br />Open Market Contract El Amendment/Addendum <br />Bid Opening F] Bid Award <br />Quote Opening El Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. Traffic Control <br />® Other: P!.osal Award <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 />Amount of <br />Previous Amount <br />R <br />Information <br />All <br />Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />HWC Eta <br />YeS If Yes, Approved by Purchasing <br />[� No <br />MBE ❑ MBE <br />WBE ❑ WBE <br />Olive Street oad Reconstruction <br />SA Professional�.�,.�_.�..�. Services <br />....._ _... �..�.���.� <br />251-0608-431 <br />31 06 ��.IT�..._._...._..____........� <br />Increase <br />Decrease <br />❑ Title Sheel <br />on for Olive Street Road Reconstruction. <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />_ <br />Increase <br />Total Percent of Change: <br />Decrease mm.....% <br />Time Extension Amount: <br />New Completion Date: <br />