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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/17/2020 <br />Name Zach Hurst Department DPW <br />BPW Date 03/24/2020 Phone Extension 3057 <br />Review and A�vl llec aired Prior to Submittal to Board <br />Diversity Compliance Officer Name Michael Patton <br />and Inclusion Officer <br />BPW Attorney ! Attorney Name Clara McDaniels <br />Dept. Attorney ❑' Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Tvpe — Reauin <br />L..J Professional Services Agreement IJ Contract <br />❑ <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />❑' <br />Quote Opening <br />El Quote Award <br />Proposal Opening <br />Q C/O & PCA No. <br />(� <br />Chg. Order, No. <br />El Traffic Control <br />F-1 Other: <br />Information <br />Company or Vendor Name <br />d or All Submissions <br />0 Proposal <br />❑ Special Purchase, QPA <br />® Req. to Advertise ® Title Sheet <br />❑ Reject Bids/Quotes <br />PCA <br />El Resolution <br />F Ease./Encroach <br />❑ Yes If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE/WBE Contractor <br />❑ MBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Press Ganey Administration Buildin Site Im rovements <br />Project Number <br />119-061 <br />Funding Source <br />RWDA TIF <br />Account No. <br />324-1050-460-42.02 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />I e uest to Advertise for Tllm-lunded site improvements at the new Press <br />Gancy Administration Building iit lgvnition I -lark, <br />_._____ ..- ................ ......... _........... _ ...._ <br />For Chat � Orders Oral <br />❑ Increase...... $ ._ <br />Amount of ❑ Decrease _( <br />Previous Amount $ — <br />Increase <br />wip <br />Current Percent of Change: Decrease %) <br />New Amount $ LA kh 0 A OAnh <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />..................... <br />