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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/17/2020 <br />Name Adam Parsons Department Central. Services <br />BPW Date 2/25/2020 Phone Extension 9302 <br />,�WW II Eft IOM�6'fik yryyy ••• "°�191d &]'.,t4F"!!R <br />_._......Review and Approval Required Prior to <br />pP q Submittal to Board <br />Diversity Compliance ❑ Officer Naine <br />and Inclusion Officer <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name Eliot Anderson <br />Purchasing <br />FOR <br />Check the <br />Professional Services Agreement <br />LJ Open Market Contract <br />F Bid Opening <br />® Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <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 />ite Item Type - <br />Contract <br />aired 1°br All Submissions <br />Amendment/Addendum <br />❑ Bid Award <br />❑ Quote Award <br />C/O & PCA No. <br />E] Traffic Control <br />TBD <br />Yes <br />F-1 No <br />uired Information <br />Proposal <br />Special Purchase, QPA <br />F1 Req. to Advertise <br />[] Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />If Yes, Approved by Purchasing <br />❑ Title Sheei <br />FIWBE MBE Completed E-Verify Form Attached El es <br />Le al Department Solar <br />Legal Department Office Supplies <br />101-0501-415.21-04 _ ......................._ <br />TBD <br />Lump Sum <br />To provide and install solar shades in 6 offices in the Legal ha Department. <br />For Change Orders Only AAA �.... _.................._.. � �� <br />Amount of ❑ <br />Increase _mmm$ ...... <br />- _ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increaseo%.�.�.........__........_....w <br />_.�.�..�...�.......�..... �..._......- <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$_.....__.. <br />Increase <br />% <br />Total Percent of Change: <br />g <br />Decrease <br />�. % <br />Time Extension Amount: <br />��.....�.�.................. �..... <br />New Completion Date: <br />