Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />Feb 13„ 2020 <br />Marlaina Johns <br />Department Code <br />BPW Date Feb 18 2020 Phone Extension 5907 <br />1 uird Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ® Attorney Name Thomas E. Panowicz <br />Purchasing <br />Check the AppLoTriate Item T e -- ui�ro <br />F] Professional Services Agreement [Z Contract <br />D Open Market Contract ® Amendment/Addendum <br />R Bid Opening ❑ Bid Award <br />El Quote Opening El Quote Award <br />Ej Proposal Opening C/O & PCA No. <br />F� Chg. Order, No. Traffic Control <br />n 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 />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />[� PCA <br />[� Resolution <br />Ease./Encroach <br />Thomas General Construction <br />�. .......- <br />❑ Yes❑ If Yes, Approved by Purchasing <br />❑ No <br />MBECompleted E-Verify Form Attached Nos <br />Amend board -up service contract to extend duration of contract <br />For ari Orders ""OfA" <br />Increase $ <br />Amount of _--- --- <br />❑ Decrease ($� <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease �_ % <br />............. <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease %) <br />Time Extension Amount: oS q New Completion Date: I S t. —,, <br />