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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/2/19 <br />. . ......... <br />Name Lauren TraDD Department Utilities <br />BPW Date 12/10/19 Phone Extension 5852 <br />Requited P nor,to,,Subm'ittal to,Board <br />BPW Attorney E] Attorney Name <br />Dept. Attorney EJ Attorney Name <br />................. ............. <br />Purchasing 1:1 <br />LJ Professional Services Agreement LJ Contract <br />Open Market Contract <br />F-1 Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />El Chg. Order, No. <br />❑ Traffic Control <br />N Other: Industrial Discharg <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 />H Proposal <br />Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheet <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />❑ Ease./Encroach <br />.............. - . .. . . ........... <br />❑ Yes[:] If Yes, Approved by Purchasing <br />F-1 No <br />[:] MBE Completed E-Verify Form Attached Yes <br />F WBE E] No <br />al7, -f <br />increase <br />Amount of❑ <br />. .......... <br />Decrease <br />($ <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 />9.1 <br />Increase % <br />Decrease % <br />Increase % <br />.................... <br />Decrease % <br />