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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/16/2019 <br />_Name Da tel Buc.... <br />enure er...Department DCI ... ..� _... ...�_.._.. <br />BPW Date I2/I9f019 Phone Extension 5823 <br />GG![�EfbNANWN'M'M'M'M6R�MISNM i �v�r ,,,,, anNXIM'�'N�1�/�IN.W�+v./✓e .E�k. ��W�'S1A�J�NRI N�idI0�N6A�W�VIIWIM � � W1d1W�WVi4'W4fM1s,�HHAYIANifilWkl�"Rdi�J�I�F.�iAkMtMX <br />Ike u�eITPrior to Submittal to Board _�..��.�.. <br />BPW Attorney ....... ,, �] ......_ �...._...... <br />Attorney Name <br />Dept. Attorney [ Attorney Name Sandra Kennedy <br />Purchasing ���..__.... ....,. <br />❑.. .... .._..__ _. ..W..� <br />Check the <br />Professional Services Agreement <br />❑ Open Market Contract <br />❑J Bid Opening <br />[] Quote Opening <br />] Proposal Opening <br />Chg. Order, No. <br />M 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 />❑ Contract <br />X Amendment/Addendum <br />Bid Award <br />Quote Award <br />], C/O & PCA No. <br />] Traffic Control <br />Information <br />All Submissions <br />Proposal <br />] Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />7 Ease./Encroach <br />❑ Title Sheet <br />Truck Driver Institute_ __.....................,__> <br />.�m.— .....m �. ���� ..... ...—.�� <br />0 Yes] If Yes, A..., pproved b y Purchasing <br />X No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE ❑ No <br />Pathw GProararn.......e._�... �. <br />EDIT_ _ <br />404-1001-460-3 9. _ 30 <br />Trainin rograms to train necessary skills to under skilled workers to meet <br />labor needs in the community. <br />_� �, Orders 9 .......mm _._. �. <br />�::....... _.� �.�. .....e. ....._.For C�.... "�_.._..... ......,�. <br />Amount of El Increase $ <br />Decrease _($ <br />Previous Amount ... ............................m r ..... <br />Increase <br />Current Percent of Changer Decrease..............%..........m_............�_..� ...............,__ _ ..�..........._—.......� <br />New Amount $_ <br />.m.Increase %.._. <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: .�.. ,_ ........ m..._. <br />