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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/11/19� w�_..__� ....................__........ _. <br />Name Alicia Czarnecki Department Engineering <br />BPW Date 12/19/19 Phone Extension 5903 <br />N� mm <br />Re( uired Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney <br />F-I Attorney Name <br />Purchasing <br />............ <br />❑ <br />..._.�. <br />Check the Appropriate Item T e �- Rlelqu�� ceI or AllmSubmissions <br />❑ <br />Professional Services Agreement ❑] Contract <br />❑ <br />Proposal <br />❑ <br />Open Market Contract <br />® Amendment/Addendum <br />❑] <br />Special Purchase, QPA <br />❑ <br />Bid Opening <br />❑ Bid Award <br />❑] <br />Req. to Advertise <br />❑ Title Sheet <br />[❑ <br />Quote Opening <br />❑ <br />Quote Award F-] <br />Reject Bids/Quotes <br />❑ <br />Proposal Opening <br />❑] <br />C/O & PCA No. <br />PCA <br />❑ <br />Chg. Order, No. <br />❑ <br />Traffic Control <br />] <br />Resolution <br />❑] <br />Other: <br />❑ <br />Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />WBK Engineering, LLC <br />. _ <br />❑ Yes❑ If Yes, Approved by Purchasing <br />._........ ................................................................. _... . _ <br />New Vendor <br />❑ No <br />❑ <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached <br />Nos <br />Project Name <br />VPA Athletic Court Renovations <br />Project Number <br />__.._..-..-..-..._.-.............................................. <br />118-098 <br />Funding Source <br />Engineering Professional Services <br />Account No. <br />101-0602-431-31-06 <br />Amount <br />Amendment 1: $6,500.00 New Contract Amount: $55,000.00 <br />Terms of Contract <br />NTE <br />Purpose/Description <br />Amendment 1 for the additional services o[re-RqgkagiEg_�uote <br />document <br />for 2020 biddiM <br />-❑ <br />m.m._ .. <br />For C� an.E (?rders r y <br />.�...� <br />Amount of <br />❑j <br />Increase $ <br />Decrease ($ <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />(�% <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( % <br />Time Extension Amount: <br />New Comnletion Date: <br />