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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/2 /2020 <br />Name Toy Villa Department Engineer►n <br />BPW Date 3/10/2020 Phone Extension 5920 <br />Lured Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the A propri to Item Ty awequ <br />El <br />Professional Services Agreement] Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />❑ <br />Quote Opening <br />❑ <br />Quote Award <br />F <br />Proposal Opening <br />C/O & PCA No. 1(final) <br />Chg. Order, No. <br />Traffic Control <br />❑ Other: <br />Information <br />All Submissions <br />LJ Proposal <br />E] Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />O.Ease./Encroach <br />Company or Vendor Name Clean Air Environmental Services„ Inc. <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 />LJ Yest If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached <br />❑ WBE <br />Fire Stations 3 & 6 Abatement <br />118*047A <br />Fire Professional Services / Other Professional Services <br />101.0901.422.31.06 <br />$7,900.00 <br />Closeout <br />For Change Orders Onl <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />-------------- <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease (o °) <br />New Amount $ <br />Increase % <br />................. ..... .._______.-_____.._ www <br />Total Percent of Change: Decrease (%) <br />Time Extension Amount: <br />New Completion Date: <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />