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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/10/19 <br />Name Alicia Czarnecki Department Engineering <br />BPW Date 12/19/19 Phone Extension 5903 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing 1:1 <br />Check the Anprooriate Item T <br />JL<J Professional Services Agreement "� Contract <br />E] Open Market Contract <br />❑ Amendment/Addendum <br />r-] Bid Opening <br />❑ Bid Award <br />❑ Quote Opening] <br />Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />n 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 />Information <br />LLC <br />All Submissions <br />LJ Proposal <br />�] Special Purchase, QPA <br />[� Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />If Yes, Approved by Purchasing <br />❑ Title Sheet <br />WBECompleted E-Verify Form Attached ❑❑ Nos <br />Bowman Creek Improvements at Lincoln Way East <br />__M ...... . .......... <br />119-085 <br />.......... <br />, ineerin Professional Services <br />.____ <br />101-0602-431-31-06 <br />$40,700.00 <br />.......................... <br />NTE <br />Preliminary engineering for improvements to Bowman Creek near Lincoln <br />Way East. <br />For Chan <br />e Orders Only <br />Amount of <br />Increase $ <br />�] <br />Decrease ($ <br />) <br />Previous Amount <br />$ <br />... .__.......... .............................................._ <br />Increase <br />..- .............. ..... ............ <br />% <br />Current Percent of Change: <br />Decrease <br />( %) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />( % o) <br />Time Extension Amount: <br />New COInDletion Date: <br />