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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Januall 7 20 <br />Name Scott <br />Department Public <br />Works <br />BPW Date JanuarX 14 2020 Phone Extension 9245 <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney El Attorney Name <br />Purchasing ❑ Michael. Scbrnidt <br />Check the A iw riatd Item T <br />Professional Services Agreement <br />❑ Contract <br />Open Market Contract <br />[ Amendment/Addendum <br />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 />Other: <br />Required Information <br />Company or Vendor Name <br />d br All Submissions <br />F Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />New Vendor H YesU If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor � WBE Completed E-Verify Form Attached <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Main Street Culvert Inlet <br />.............. .............. <br />_ <br />120-016 <br />Sewer Contractual <br />641-0621-792.63-35 <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />Lump Sum <br />Debris cleanout of Bowman Creek in addition to the c ulvert at South Main <br />St� <br />Fof Chan e `Orders Onl <br />Increase $ .. .... <br />Amount of .... <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase % <br />..........w.............. ......................... <br />Current Percent of Change: Decrease %) nmm <br />New Amount $ <br />.............. <br />................ _.. <br />Increase % <br />Total Percent of Change: Decrease ( ........ ....... <br />Time Extension Amount: <br />........................._ ------ ..... ............... ...... <br />New Completion Date: <br />