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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/3/20 <br />Department <br />Name Kyle Silveusmmw En ineerin <br />BPW Date 2/11/20 Phone Extension 9083 <br />_ .. <br />Review and A�vroval 'alit-e€ Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />BPW Attorney ZAttorney Name Clara McDaniels <br />Dept. Attorney E] Attorney Name <br />................................. <br />Purchasing <br />Check the Ap topt iatiW Item 1" --tic <br />E] Professional Services Agreement E Contract <br />Open Market Contract ❑ Amendment/Addendum <br />�j Bid Opening ❑ Bid Award <br />❑ Quote Opening El Quote Award <br />Proposal Opening R C/O & PCA No. <br />[] Chg. Order, No. E] Traffic Control <br />F 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 />H Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise <br />E] Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />® Title Sheel <br />N/A <br />YesF� If Yes, Approved by Purchasing .._ .................................... <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Eagle Way Sewer Extension <br />119-095 <br />_.._.�.................. <br />RWDA TIF <br />324-1050-460-31.02 <br />N/A <br />Extension of Gravity Sewer from Eagle Way. to Nimtz Pkwy. <br />For Clam <br />Amount of Increase $ . <br />❑ Decrease _ apt <br />Previous Amount $ _. _ .... <br />Increase _ % I. E _I t ZOLO _w <br />Current Percent of Change: Decrease 0 <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease fmmmmmmmmmmm m%> M <br />New <br />e E a ralct re ntADate mount-, 7 <br />