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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/05/2019 <br />Name Ttv Villa <br />BPW Date <br />------------- <br />I <br />Department Engineering <br />Phone Extension 5920 <br />l mltwetl Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing F <br />Check the ApLpriatItem'' pe- d�ii <br />Professional Services Agreement EJ Contract <br />Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening [❑ Bid Award <br />�] Quote Opening Quote Award <br />(� Proposal Opening FJ C/O & PCA No. <br />Chg. Order, No. Traffic Control <br />❑, 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 />Required Information <br />All Submissions <br />" Proposal <br />E] Special Purchase, QPA <br />❑ Req. to Advertise <br />[] Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Shamba�gl w& Son, LP <br />___________________ .-........... <br />❑ YcsEJ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE No <br />HydrantFlowTesting <br />119-041 <br />.... <br />Water _. _.............................. ............ <br />Works Professional Services <br />620.0640.658.31.02 <br />$37,145.00 <br />Project Closeout <br />For C hange Orders Only <br />Amount of El Increase _w_$ <br />Decrease �$ )....._.. .. <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />.........ITIT..._..... <br />Total Percent of Change: Decrease ( % ...............__-.________..._. <br />Time Extension Amount: <br />New Completion Date: <br />