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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/04/2019 <br />Name Daniel, Buckennre e-r Department DCI <br />BPW Date 12/l�/2019 Phone Extension -925--- r 36 <br />WDNW9RRINi.N{.l'ICI'M'NIk9W�W�WWiWY!�!1�I.�N�K'iv�e�.� f�.�lllllltt <br />to Submittal... _::..._. to Board <br />R��tflmPrior <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name Sandra Kenned <br />Purchasing <br />Check the apt°o ri ate Item '°1 ape w ,� x 1,1 <br />E] Professional Services Agreement X Contract <br />Ej Open Market Contract ❑ Amendment/Addendum <br />Bid Opening EJ Bid Award <br />{� Quote Opening Quote Award <br />�] Proposal Opening C/O & PCA No. <br />❑ Chg. Order, No. ❑ Traffic Control <br />F-1 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 />E]Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />EJ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Recast Boost <br />Yes I ...� _ __ ---------- <br />f Yes, Approved by Purchasing <br />X No <br />F❑ MBE Completed E-Verify Form Attached No <br />WBE <br />Recast Boost Contract <br />EDIT <br />_ _ 001-4 0.39.30 <br />$29,000.00 <br />Under the Agreement, the Consultant will work with the undersigned to <br />conduct a 4-month Recast Boost for the target jurisdiction and property.. <br />Amount of Increase $ <br />EJ Decrease$ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Increase % <br />Decrease (..._W.. <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: .....................__ <br />