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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/13/2019 <br />Department Public <br />Name Tom_ Works <br />BPW 019 Phone Extension Date 09/24/2 n 5920 <br />�.......... _.... _..... _ ... _. ...............w _�. ,_... _....... <br />lcu�rd Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ❑ <br />Check the Ap r:•opri ale Item Type — Reat <br />Professional Services Agreement Contract <br />El Open Market Contract El Amendment/Addendum <br />Ej Bid Opening El Bid Award <br />Quote Opening El Quote Award <br />❑ Proposal Opening [:1 C/O & PCA No. <br />E] Chg. Order, No. El Traffic Control <br />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 />Information <br />i ~ iga�losep t. <br />For Ch ige Orders 011 <br />Amount of <br />Increase $...............�m. - <br />��...................._�� <br />Decrease ($ <br />Previous Amount <br />$ <br />Increase <br />Current Percent of Change: <br />Decrease <br />( % <br />New Amount <br />$ _ <br />....Increase ....m.�..�.........aY_ <br />���.%.... <br />Total Percent of Change: <br />Decrease <br />% <br />Time Extension Amount: <br />New Completion Date: <br />All Submissions <br />L. Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />