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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/19/19 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date 1/14/20 Phone Extension 9245 <br />NNM <br />..... <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the A vropria(e Item Tw —. <br />LJ Professional Services Agreement H Contract <br />[� Open Market Contract <br />Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />EJ Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />® Traffic Control: <br />Residential Ha�1�dica <br />PLrrki g <br />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 />All Submissions <br />L J Proposal <br />E] Special Purchase, QPA <br />Req. to Advertise <br />0 Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />---❑Yes _❑ If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑l No <br />217 E Po agon St. Res_idential Handicap Parking <br />............. <br />mw <br />Recommend A royal. Residents location does not allow for access foi <br />his van. <br />El increase <br />$ <br />Amount of �._...._ ............ .._ . d.w <br />Decrease ($ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase <br />% <br />..... ..... <br />Decrease <br />/o <br />Increase <br />% <br />Decrease <br />( % <br />New Completion Date: <br />