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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/2019 <br />Department <br />Name Sue Ellen Doudrick Engineering <br />BPW Date 10/22/2019 Phone Extension 5922 <br />._........__� w.w t1qiredITPrior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney -] Attorney Name <br />Purchasing <br />Check the Ap <br />Professional Services Agreement <br />F-j Open Market Contract <br />n Bid Opening <br />El 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 />4e Itemjype <br />Contract <br />❑ Amendment/Addendum <br />❑ Bid Award <br />El Quote Award <br />C/O & PCA No. <br />❑ Traffic Control <br />All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise ® Title Sheet <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />.............._..... _............... <br />Yes ❑ If Yes, Approved by Purchasing <br />�j No <br />MBE ❑ WBE Completed E-Verify Form Attached Nos <br />Small Drainage Design and Repair Overlook Court & Sampson Street <br />118-063A" <br />Storm Sewer Fund <br />667-0621-792-4204 <br />Unit prices <br />Storm sewer co ....�....�...�........�� ��....... nstruction along Sampson Street and Overlook Court to routf <br />to existing Ireland Rd Basin southwest of Overlook Court. <br />For Change Orders Only <br />Amount of Increase $ -- <br />Decrease $ ,` <br />�..........__ _..�_ --- .----------- --. <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New t ",oin letlon Date: <br />Increase % <br />Decrease (' % <br />Increase % <br />Decrease ( % <br />