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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date......m.....,.,.�. 2/17/20.�.......................�A,,,�.�..�........................................................................................_�.......... _,_ ....._.....��... <br />�..... <br />Name Liz Maradik Department DCI <br />BPW Date 2/25/20 Phone Extension X5821 <br />rmwcercwmowiwrmrd�wmmmm!mmvmra�mar arverxmerxxrmuwmomurerrmwrcairnmmurm m—nnm muem�mumremwmumr^m=+�a�mmrrs <br />Review and Approval Required Prior to Submittal to Board <br />..._.. __. ....._._ ....._....... . ._...__--.-........ ....... ...... <br />_ <br />Diversity Compliance F-1 Officer Name <br />and Inclusion Officer <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name Sandi Kenned <br />Purchasing <br />Check.the °�pj qjS Item Typ lac,- u <br />EJ Professional Services Agreement I❑ Contract <br />n Open Market Contract F-1 Amendment/Addendum <br />❑] Bid Opening ❑ Bid Award <br />Quote Opening E� Quote Award <br />Proposal Opening E] C/O & PCA No. <br />Chg. Order, No. E] Traffic Control <br />Z Other: Tem orar Access <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 />Vi <br />Information <br />All Submissions <br />❑ Proposal <br />E Special Purchase, QPA <br />❑] Req. to Advertise <br />OReject Bids/Quotes <br />F] PCA <br />Resolution <br />Ease./Encroach <br />to Village International, Inc. <br />L_J YesLJ If Yes, Approved by Purchasing <br />No <br />MBE MBE Completed E-Verify Form Attached Nos <br />cn�pgrq� cce ,s Agreement <br />.... ...... ..... <br />mm. <br />❑ Title Sheei <br />Temporary access to City owned property to complete preliminary work <br />related to potential development. <br />For Change. Orders Only <br />Amount of 1:1 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 Completion Date: <br />Increase % <br />Decrease ................�.�........% <br />Increase % <br />Decrease ( % <br />