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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date04/08/2020 <br />DepartmentPublic <br />NameZach HurstWorks <br />BPW Date04/14/2020Phone Extension3057 <br />Required Prior to Submittal to Board <br />BPWAttorneyAttorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the Appropriate Item Type –Required for All Submissions <br />Professional Services AgreementContractProposal <br />Open Market ContractAmendment/Addendum Special Purchase, QPA <br />Bid OpeningBid AwardReq. to AdvertiseTitle Sheet <br />Quote OpeningQuote AwardReject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic ControlResolution <br />Other: Ease./Encroach <br />Required Information <br />Companyor Vendor NameM/E Design Services <br />YesIf Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBEYes <br />MBE/WBE ContractorCompleted E-Verify Form Attached <br />WBE No <br />Project Name <br />Project Number <br />Funding SourceUtilities / Water Operations <br />Account No.620-0640-658.31-02 <br />Amount$1,800 <br />Terms of ContractLump Sum Contract <br />Purpose/DescriptionSee attached memo. Contact is Tom Cooktcook@m-e-design.net. <br />For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease($) <br />Previous Amount$ <br />% <br />Increase <br />Decrease(%) <br />Current Percent of Change: <br />New Amount$ <br />% <br />Increase <br />Decrease(%) <br />Total Percent of Change: <br />Time ExtensionAmount: <br />New Completion Date: <br />