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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/17/2019 <br />Department <br />Name ToVilla..............................._... wwww... Engineering . _ ..... __... - --- <br />BPW Date 6/25/2019 Phone Extension 5920 <br />Rec uired Prior to Submittal to Board <br />_....... __ :w. __._._ ................._....._...... .............._ <br />BPW Attorney Attorney Name <br />Dept. Attorney n Attorney Name <br />Purchasing <br />Check the Appropriate m Type 1��q� <br />[� Professional Services Agreement [:1 Contract <br />❑ Open Market Contract Amendment/Addendum <br />E] Bid Opening Bid Award <br />Quote Opening Quote Award <br />F] Proposal Opening ® C/O & PCA No. 1 Final <br />❑] Chg. Order, No. ❑ Traffic Control <br />Other: <br />_ ................ <br />_.__... _._...._ <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 />rqj Closeout <br />All Submissions <br />LJ Proposal <br />F] Special Purchase, QPA <br />[] Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑] PCA <br />�] Resolution <br />EJ Ease./Encroach <br />❑ Title Sheet <br />For C an e Orders On] <br />._ ..._�� : W ... <br />Amount of ❑ Increase $ ............... <br />Decrease $ 14,510.87 �........ <br />Previous Amount $ 661,895.99 <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />% <br />Decrease <br />(2.19% <br />. ........................ <br />$ 647,385.12 <br />Increase <br />12.72% <br />Decrease <br />(%�)..... <br />