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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/2/19 <br />Name Alicia 0arnecki/Ro er° Nawrot Department l_a� i eerinc , <br />...­- .. ...... ......... .. ........ , <br />BPW Date 12/10/19 Phone Extension 5903 <br />1wwau�mowmmomo�MM <br />`;fie mired Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney F-1 Attorney Name <br />.....__ .......... ------ <br />Purchasing <br />Check the A ?rt ria a Item TM_(--,i4 <br />12 Professional Services Agreement [� Contract <br />Open Market Contract ❑ Amendment/Addendum <br />0 Bid Opening E, Bid Award <br />❑ Quote Opening El Quote Award <br />❑ Proposal Opening R C/O & PCA No. <br />El Chg. Order, No. ❑ Traffic Control <br />[J 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 />fy <br />l Submissions <br />Information <br />L Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />Resolution <br />❑ Ease./Encroach <br />HC <br />YEn �i��ee� in ............. <br />es If Yes, Approved by Purchasing <br />No <br />MBE WBE Completed E-Verify Form Attached <br />Olive Street Road Reconstruction <br />114-064 <br />LRSA Professional Services <br />251-0608-431.31-06 <br />$448„512.95..�..........�.,. �..... <br />Hourly NTE ..........m ..,,,.r <br />❑ Title Sheei <br />Yes <br />No <br />Construction Inspection for Olive Street Road Reconstruction. <br />Amount of � <br />increase $ <br />Decrease <br />Previous Amount <br />........--...�_.ww. <br />$ <br />Increase <br />Current Percent of Change: <br />Decrease (mm........_w%) <br />New Amount <br />Increase <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />