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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/15/2020 <br />Name _. Todd Skwarcan, Fire �rChief <br />a .. ... <br />w . Chi et Department Fire <br />BPW Date 1/28/2020 Phone Extension 9255 <br />.. .. w�wo. mnra�rur rwwrar wwwnsu�u w��as Wmrrvrvrvrvmomrrvrvrvm�wuwuuuuuuuuuuuuuuumumwm!muuuuuuuuuuuuuuuuuuuurrnrr�imi apmruww�rwvwirrt rmm�ra !m ,�....., ...... rmwiuwwiOR <br />Review and A aJ ru l l wired Prior to Submittal toBoardmm <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney E j Attorney Name <br />Purchasing <br />Checkthe,J <br />rqpjjq,,Item Tyl? c t <br />[� Professional Services Agreement Contract <br />Open Market Contract <br />Amendment/Addendum <br />0 Bid Opening <br />Bid Award <br />L-1 Quote Opening <br />Quote Award <br />Ej Proposal Opening <br />❑ C/O & PCA No. <br />[❑ Chg. Order, No. <br />Traffic Control <br />F1 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 />H YesL <br />[� No <br />[� MBE <br />❑ WBE <br />All Submissions <br />Ll Proposal <br />E Special Purchase, QPA <br />Req. to Advertise <br />Lei Reject Bids/Quotes <br />PCA <br />® Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />u�ircd Information <br />If Yes, Approved by Purchasing <br />Completed E-Verify Form Attached ❑ Yes <br />❑ No <br />—Disposal of Unfit Property/Helmets & Boots — Retirees John Corthier, <br />Assistant Chief, Training; Federico Rodriguez, Fire <br />Marshal <br />m :. ........ . ...m...._ ..... <br />or Change Orders <br />Only <br />. F Ordwm m w __.... <br />Amount of ❑ Increase $ <br />Decrease <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Co nioletion Date: <br />M <br />Increase <br />Decrease ( % <br />Increase % <br />Decrease ( % <br />