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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />DateApril 22, 2020 <br />DepartmentPublic <br />NameScott KreegerWorks <br />BPW DateApril 28, 2020Phone Extension9245 <br />Required Prior to Submittal to Board <br />BPWAttorneyAttorney NameClara McDaniels <br />Dept. AttorneyAttorney Name <br />PurchasingMichael Schmidt <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: Public Notice of Ease./Encroach <br />Intent to Self-perform Paving <br />Required Information <br />Companyor Vendor Name <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 Name2020Annual Paving Program <br />Project Number n/a <br />Funding SourceMVH <br />Account No.n/a <br />Amountn/a <br />Terms of Contractn/a <br />Purpose/Description_Notice ofIntent to self-perform workusing City forces for projects greater <br />than $100,000________________________________________________ <br />For Change Orders Only <br />$ <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 />