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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />03/16/2020 <br />Tov Villa <br />Department Engineering <br />BPW Date 03/24/2020 Phone Extension 5920 <br />........ .w. . ................ <br />l to Submittal to Board e}uutl Pnor...... .................. .._ <br />BPW Attorney EJ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the <br />E] Professional Services Agreement <br />Open Market Contract <br />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 />le Item "1 me -- <br />Contract <br />❑ Amendment/Addendum <br />El Bid Award <br />El Quote Award <br />C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />Proposal <br />E] Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />El Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Midland Engint,o��mg.......... ................... ...._......._..� <br />0 Yes ❑ If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached El Yes <br />[❑ WBE No <br />Vested Interest Building Roof Repair.-,....... <br />119-049 <br />RWDA F _ <br />324-1050-460-42.02 ..... <br />_......................... <br />$248,088.10 <br />Project Closeout <br />__uu_ <br />For +."�t���xe Orders Only <br />�......_��� � ...._.. <br />Amount of ❑ Incr $ _ ......................w ........ <br />E] Decrease ($ ) <br />Previous Amount $ <br />Increase % <br />_ <br />g �........... ............ <br />__u <br />Current Percent of Chan e: Decrease _. <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease IT% <br />Time Extension Amount: <br />New Completion Date: <br />