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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1"4'1 2 , 2019 . <br />Name David Relos Department DCI <br />BPW Date May 25 2019 Phone Extension 5836 <br />�amuvrw��mw,�aw,uw�m��weneimaarvrummimwnwx�mr�rmwrmuomw�ruw�mmmmm � mm�rr <br />.._...�,............,_..—�._..,.........................................W.W. <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels �.........__._.......... <br />Dept. Attorney ® Attorney Name Sandi Kenned <br />Purchasing ❑ <br />Check the A a area ariate Item 1`y ae - Aee to <br />Professional Services Agreement Contract <br />E Open Market Contract Amendment/Addendum <br />[ Bid Opening Bid Award <br />Quote Opening Quote Award <br />❑ Proposal Opening C/O & PCA No. <br />[] Chg. Order, No. E] Traffic Control <br />E] 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 />Amount of <br />Previous Amount <br />uired Information <br />All Submissions <br />LJ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Z Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Ike aft. of Community Investment <br />[J Yes F If Yes, Approved by Purchasing <br />[ No <br />MBECompleted E-Verify Form Attached ❑ Nos <br />510 S. Main St. <br />Approve possible acquisition of 510 S. Main St. and authorize David Relos <br />to act on the Board's behalf. <br />[-1 Increase <br />[J Decrease <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />For Change Orders Onl <br />Increase % <br />Decrease % <br />Increase % <br />...................................................... <br />Decrease ( % <br />