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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />06/24/2019 <br />Tov Villa <br />Department: Engineering <br />BPW Date 07/09/2019 Phone Extension 5920 <br />mauxrxr i�rr�eu�n. w�mmm�uouuuuuuuuuuumnnmimmmmmmmmmmmmmmmmmuuuuuuuuuuuumwwwmmmumm imwimumi <br />�Required Prior to Submittal to Board �....._ <br />IT BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Aq�Propriat Item Type — l ruxr <br />Professional Services Agreement Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />Bid Opening Bid Award <br />Quote Opening ❑ Quote Award <br />EJ Proposal Opening C/O & PCA No. <br />F Chg. Order, No. ❑ Traffic Control <br />17 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 />Pro 'Cct Closeout <br />l6r All Submissions <br />❑ Proposal _.._...._ <br />❑ Special Purchase, QPA <br />E] Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />1 Ease./Encroach <br />..... <br />Cl����~�:c Orders O��ky <br />Amount of Increase $....... <br />Decrease ($ <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease %) <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease (. % .._.. <br />Time Extension Amount: <br />New Completion Date: <br />