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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 3, 2020 <br />Department <br />Name Jacob M. Klosinski En ineerin /Utilities <br />BPW Date February 11, 2020 PhWMWone Extension Ext. 9496 <br />00� <br />_Review and Apprcvi Reo�uired Prior to Submittal to Board <br />__. <br />Diversity Compliance ® Officer Name Michael Patton <br />and Inclusion Officer <br />........BPW Attorney Attorney Attorne NClara M._..cDaniels <br />...-_...._�r.._ <br />_.. <br />Dept. Attorney ® Attorney Name Clara McDaniels <br />Purchasing E Michael Schmidt <br />Check the <br />❑ Professional Services Agreement <br />❑ Open Market Contract <br />F Bid Opening <br />[] Quote Opening <br />Proposal Opening <br />❑ Chg. Order, No. <br />E] 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 />to Item Type <br />Contract <br />❑ Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />F] C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />Li Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />Ej Resolution <br />Ease./Encroach <br />® Title Sheei <br />.............. __._ �............�...�._. wmw�....... <br />YesF-1 If Yes, Approved by Purchasing <br />F] No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑ No <br />CSO 003 Backwater Valve Replacement <br />_....�� ............. <br />119-113 <br />Utilities, Sewage Works Op <br />erations, Contractual Services Other <br />641-0630-793-6335s_____ <br />Sum <br />Purpose/Description The Division of l ngi11c1q in Requests the Board of Public Works approval <br />the Title Sheet and Request to Advertise for the subject ro'ect The promos <br />MWBE Goal for this prgject was „reviewed on 01/29/2020 and determined 1 <br />be 5.00% Advertise 02/21 & 02/28/2020. Bid Onenin 03/'1.0/2020. <br />Amount of <br />Previous Amount <br />❑ Increase <br />❑ Decrease <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />E19 <br />Increase % <br />Decrease .................... % <br />/o <br />Increase % <br />Decrease ( % <br />New Conmletion Date: <br />