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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/5/2019 <br />Department <br />Name Sue Ellen Doudrick—.-,, . . . . ............ - Engineering­,­ <br />BPW Date 2/12/2019 Phone Extension 5922 <br />Required Prior to Submittal to Board <br />BPW Attorney Ej Attorney Name Clara MeDaniels <br />.......... <br />. ........... <br />Dept. Attorney ❑ Attorney Name Clara McDaniels, <br />........ .. ......... . . . . . . ..... <br />Purchasing ❑ Michael Schmidt <br />. . . .... ...... . -- - ---- <br />Check the Appropriate Item <br />0 Professional Services Agreement F Contract <br />Open Market Contract <br />[] Amendment/Addendum <br />Bid Opening <br />Bid Award <br />❑ Quote Opening <br />❑ Quote Award <br />F] Proposal Opening <br />❑ C/O & PCA No. <br />n Chg. Order, No. <br />E] Traffic Control <br />D_Q!her. <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 />uired Information <br />All Submissions <br />H Proposal <br />E] Special Purchase, QPA <br />Z Req. to Advertise <br />E] Reject Bids/Quotes <br />E] PCA <br />Resolution <br />Ease./Encroach <br />. . ...... ..... <br />Z Title Sheet <br />H Yes LJ If Yes, Approved by Purchasing <br />[:] No <br />F] MBE [:] WBE ElNosCompleted E-Verify Form Attached <br />[:] <br />West Bank Trail Corridor Improvements <br />... . .. Improvements <br />...... <br />. . . . ....... .. <br />117-085 <br />Unit Prices <br />- I..... <br />............ <br />Trail along the west bank of St. Joseph River from south of Jefferson Blvd t( <br />Century Center and from Pier Park to LaSalle. <br />West Gate Repairs to the West Race. <br />....... ....... -..- For Change Orders Only ­ <br />Amount of E] increase $ <br />r-1 Decrease ($ ................. A rrQ I <br />Previous Amount . . . ........... 71 <br />Increase % <br />Current Percent of Change: Decrease % <br />. . . ......... <br />New Amount $ <br />Increase % <br />. ............... . <br />Total Percent of Change: Decrease %) <br />Time Extension Amount: <br />New Completion Date: <br />.................. . ........ . . . . .......... <br />