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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date Izo <br />Name w Department <br />BPW Date___ <br />ension <br />Phone Ext,.._.._�..........w_.....�-------__...._. <br />_am „ , lec trd Prior to Submittal to Board <br />Review and A royal _...._ _ ..... mw <br />Diversity Compliance Officer Naine <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name i <br />Dept. Attorney E] Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Type -- <br />U Professional Services Agreement ❑ Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />0 Bid Opening <br />❑ Bid Award <br />L-] Quote Opening <br />0 Quote Award <br />EJ Proposal Opening <br />❑ C/O & PCA No. <br />F-1 <br />Chg. Order, No. <br />❑ Traffic Control <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 />Proposal <br />E] Special Purchase, QPA <br />Zeq. to Advertise <br />Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Yes F1 If Yes, Approved by m <br />Purchas <br />g <br />"No <br />❑I MBE Completed E-Verify Form Attached ❑ Yes <br />�] WBE <br />❑ No <br />... 1 _. <br />I <br />Amount of ❑ <br />El <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />For <br />Increase $ <br />Decrease ($ <br />Increase <br />Decrease <br />Orders <br />Increase % <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />IM <br />