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<br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />DateSeptember 9, 2020 <br />DepartmentCentral <br />NameJeff HudakServices <br />BPW DatePhone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPWAttorneyAttorney Name <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: Ease./Encroach <br />Required Information <br />Company or 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 NameSpec J - <br />Project Number <br />Funding SourceTraffic Department Lease <br />Account No.202-06-602-503-445000 <br />Amount$165,000.00 <br />Terms of ContractLease <br />Purpose/Description <br />_______________________________________________________________ <br />_______________________________________________________________ <br />________________________________________________ <br />For Change Orders Only <br />$ <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 />TimeExtensionAmount: <br />New Completion Date: <br />