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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />12-13-19 <br />Michelle Smith <br />Department Utilities <br />BPW Date 12-19-19 <br />io�rmn �rmmmmuux mamrr.�rc v�ar„wPhone Extension 5994 <br />uuuuuuH <br />UPPPPMmmmmmmMMMEMIuuuuwuuuuuuuumnu <br />r�..�........� ..... .�,...... �,.....�.... ............ ..... <br />Rcquired Prior to Submittal to B m <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing Fj <br />Check the <br />Professional Services Agreement <br />❑ Open Market Contract <br />In Bid Opening <br />Quote Opening <br />Proposal Opening <br />❑ Chg. Order, No. <br />❑ Other: <br />ate Item r p _:-- <br />Contract <br />E] Amendment/Addendum <br />Bid Award <br />Quote Award <br />C/O & PCA No. <br />j Traffic Control <br />Company or Vendor Name U.S. D( <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 />Information <br />All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheei <br />Reject Bids/Quotes <br />0 PCA <br />Resolution <br />Ease./Encroach <br />rtment of the Interior/U.S. S. Geological S <br />E] Yes 0 If Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached ® Yes <br />❑ WBE ❑ No <br />Joint Funding Agreement for Water -Resource Investigations <br />..........„m <br />NFOOGWO <br />Water Works Operational Fund <br />......._� ............................... . ............... . <br />620.0640.603.31.35 <br />... ..................... __.......... <br />$3000 �.�....�... <br />Annual Agreement for water level measurement and analysis <br />For Change Orders Only <br />Amount of <br />❑ <br />Increase <br />Decrease <br />Previous Amount <br />_.�$ ...._..........� <br />$_._..._............................rw <br />_......_.............w_wwwwww <br />Increase <br />......_............ w <br />% <br />Current Percent of Change: <br />Decrease <br />%) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease ( <br />%) <br />Time Extension Amount: <br />New Completion Date: <br />