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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 7, 2020 <br />Department <br />Name Kara Boyles Engineering <br />BPW Date Januar 1.4 2020 Phone Extension 5933 <br />=nM <br />Review and A proval Rewired Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />�................... .._.��....._.................. Clara McD�anYe ....._. �����_.........__... <br />BPW Attorney Attorney Name C.l is <br />Dept. Attorney ] Attorney Name <br />Purchasing 1:1 <br />Check the Appropriate Item <br />L J Professional Services Agreement H Contract <br />❑ Open Market Contract <br />® Amendment/Addendum <br />❑ Bid Opening <br />0 Bid Award <br />Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />M 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 />All Submissions <br />❑ Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />F] PCA <br />E Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Black & Veatch <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />�] WBE ❑ No <br />.. <br />Olive Water Treatment Plant Improvements <br />118-024 <br />Water Works Professional Services <br />620-0640-658.31-02 <br />$15,915 <br />Lump Sum <br />Amendment 3 to PSA for Design Services <br />For Chang Orders On1- <br />Amount of <br />Increase $ <br />❑ Decrease <br />Previous Amount $ . __w <br />..._.. .......... <br />.......__...........................................m ..... <br />Increase <br />....... ... <br />Current Percent of Change: Decrease %)����� ..... <br />New Amount $....... <br />...... ._............... ....._ ... . <br />Increase % <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: ......_ _�_................ <br />New Completion Date;.._............ ... ..-......._..............__... <br />