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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 12, 2019 <br />Name Clara McDaniels <br />Department Legal <br />BPW Date December 19, 2019 Phone Extension 5860 <br />�wmm� MMMM MMM HHKm wuoioioi re�,vnmmn <br />e,pic� l�r�ar to ��ck��ittl� t� 1�a�tl <br />BPW Attorney Z Attorney Name Clara McDaniels <br />Dept. Attorney Z Attorney Name <br />Purchasing F <br />Cbeck the <br />A ari e� jyp.All ubmiRio my <br />Professional Services Agreement _W. w <br />❑Contract Proposal <br />E] Open Market Contract Amendment/Addendum Special Purchase, QPA <br />Bid Opening Bid Award E] Req. to Advertise ❑ Title Sheei <br />Quote Opening Quote Award Reject Bids/Quotes <br />Proposal Opening EJ C/O & PCA No. ❑ PCA <br />E] Chg. Order, No. Traffic Control Z: Resolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />Yes M If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor <br />0❑ MBE Completed E-Verify Form Attached ❑❑ No <br />Project Name <br />Project Number <br />....... .............�. <br />Funding Source <br />.......................... <br />Account No. <br />Amount... <br />_.. ._.... <br />Terms of Contract <br />Purpose/Description <br />......._..................... <br />Delegation of contracting authority from the Board of Public Safety to the <br />Board of Public Works. <br />.... ..... <br />For <br />Amount of <br />Increase _..._ ..____ <br />Decrease�($ ) <br />���.������� <br />Previous Amount <br />$ �.............. <br />..................................._�.w �.._ ..�._.��..__..�_ <br />....... �w_......._.....w <br />Increase <br />........ <br />% <br />. ......................... .--w_� --- <br />Current Percent of Change: <br />Decrease <br />�..........._._. <br />%) <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />e: <br />Decrease <br />��........��......_w.__......ww............. ...... <br />°/o <br />Time Extension Amount: <br />��� ..._.._..�.............�..._�m�.� <br />New Completion Date: <br />