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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Januajj2, 2020� <br />Name David Relos <br />Department DCI <br />BPW Date Januar <br />»�um,awr�rw;r rare. �,...,'�'"'''"''o,m^,�,,.�*re"{�Ssv!w�,r�,v�,�vi�a.mw��,;;a�immoimimmvm✓�� <br />Phone Extension 5836 <br />�r,�,u�amrtmi�omirv�rvmrmr�^��r�r ¢�m�a��.��nn c�mm�muu�iuiuiuiuiuiu�urrm�w.v�r�u�u�uu�w�mvro�ertweaammimmi�� <br />Review and � � ��'oval (c� oarSubmittal <br />�.1...... w �l Prior to Submitt al to Board <br />Diversity Compliance <br />Z� <br />Officer Name <br />�o: _ aa� ..� .....� .w.,�.........� <br />_-- <br />and Inclusion Officer <br />_ <br />Aladean DeRose <br />BPW Attorne y <br />® <br />Attorney <br />y Name <br />Clara a McDanels <br />Dept. Attorney <br />E] <br />Attorney Name <br />Purchasing <br />���... <br />.. �� <br />..... _.m. . .. ...— .�. ........ <br />_ heck the Appropriate Item Tp�,, <br />Pfessional Services A ..e n" <br />. <br />Agreement Contract <br />ro <br />El Open Market Contract Amendment/Addendum <br />E] Bid Opening Bid Award <br />E Quote Opening El Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No., Traffic Control <br />ZwReaI► <br />_erEe <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 />All Submission <br />LJ Proposal <br />Special Purchase, QPA <br />EJ Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />El Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />EJ White <br />No ❑ If......- ...� _._ in ...� .. _�....�..... <br />Yes ......_ .� .....�. <br />Yes, Approved by Purchasing <br />❑ MBE Completed E-Verify Form Attached Yes <br />WBE orme..__SNo <br />r Salvation Army building (510 S. Main St.) <br />_. __. <br />20JO12 <br />460-36.01 <br />$50,2.1.9 __.,. <br />Emergency replacement of the boiler and related syste <br />ms at the former <br />Salvation Army building at 510 S. Main. <br />For Cliaw8 Orders Only.. .�.� <br />Amount of El <br />Increase $ <br />....... _ <br />Decrease$ <br />Previous Amount <br />$ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />( %) <br />New Amount <br />$ <br />_ _-_ <br />_m_ _..m. ... ... ...�.. .... _ <br />Increase <br />/o <br />TotalPercent of Change: <br />Decrease <br />��..�...................%) m..................... __....__W.........................................��...__........._....................�..�......� <br />Time Extension Amount: <br />New Completion Date: <br />