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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />. .......... . .............. <br />Date 12/4/19 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date 1/14/20 Phone Extension 9245 <br />MOM H <br />. ........... . . . . <br />_ � or to Submittal to Board <br />m. <br />BPW Attorney El Attorney Name Clara iIcDaiels <br />.......... <br />Dept. Attorney Attorney Name <br />Purchasing 1:1 <br />Check the _4pprq p1jate Item -!)me .............. . #�q-14 <br />F� Professional Services Agreement F-1 Contract <br />7 Open Market Contract EJ Amendment/Addendum <br />E] Bid Opening F-1 Bid Award <br />] Quote Opening F-1 Quote Award <br />R Proposal Opening F-1 C/O & PCA No. <br />F-1 Chg. Order, No. E Traffic Control: <br />Residential 1-Ign(licall <br />PaLk"in � <br />U Other:, <br />. . . . . . . ............ <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 />L] Proposal <br />E] Special Purchase, QPA <br />F-1 Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />El Title Sheet <br />LJ Yes H If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />❑ WBE n No <br />1422 W Indiana Ave Residential Handicap Parkin <br />.... . . .... <br />Recommend Approval . . . . . .............. . <br />......... <br />Fqr,Cbangq__ nly <br />Amount of F-1 <br />increase $ <br />. ........ <br />F-1 <br />Decrease <br />Previous Amount <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />%) <br />New Amount <br />. ... . .............. . <br />Increase <br />.... <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />