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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />3/19/2018 <br />Theresa Harrison/Alicia Czarnecki <br />Department <br />Division/Bureau <br />Public Works <br />Engineering <br />BPW Date 3/22/18 "Agenda Review" Phone Extension 5903 <br />j_j <br />Agreement Amendment <br />U Contract Lj Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />❑ id Award ❑ Req. to Advertise ❑ Title Sheet <br />® Quote Opening <br />14 <br />Quote Award <br />❑ Change Order No. <br />CIO &PCA No. ❑PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control: <br />n <br />Other: General Release <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Amount of ❑ <br />El <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />TBD <br />❑ Yes ❑ No ❑ If Yes, Approved by <br />Purchasing <br />❑ MBE ❑ WBE <br />❑ No ❑ Yes Name of Company <br />Traffic Calminq Demonstration — Engineered Rubber Curb <br />Total Percent of Change: % <br />Dis ersal.After Approval <br />Copy Original <br />® ❑ Kara Boyles <br />® ❑ Theresa Harrison <br />® ❑ Alicia Czarnecki <br />