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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/05/2019 <br />Department <br />Name Villa. ........ Engincering Division <br />BPW Date 8/13/2019 Phone Extension 5920 <br />R sired Prior to Submittal to Board <br />................._._..........�_w_.... _......_._._.__W_ ..............._ <br />BPW Attorney ❑, Attorney Name <br />Dept. Attorney F-1 Attorney Name <br />Purchasing <br />Check the Appropriate Item Type <br />❑ Professional Services Agreement ❑ Contract <br />Open Market Contract Amendment/Addendum <br />❑ <br />Bid Opening Bid Award <br />Quote Opening [' Quote Award <br />Proposal Opening C/O & PCA No. <br />Chg. Order, No. ❑ Traffic Control <br />0 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 />vdJor All Submissions <br />;Required Information <br />Construction <br />LJ Proposal <br />El Special Purchase, QPA <br />E] Req. to Advertise <br />E] Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Yes" If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE No <br />2019 Small Drainage (Lathrop) <br />............................w <br />Storm Sewer Fund <br />667.mmmmmmmmmmmmmm0621.792.42.04 <br />$36,605.40 <br />Project Closeout <br />For Clue Orders Only; <br />Amount of ❑ Increase $ <br />❑ Decrease ($ <br />Previous Amount $ <br />Increase.............._�.�.�.�.�.�.�.�.�.�.�.................. ° <br />/o <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 />