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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/16/'2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 09/24/2019 Phone Extension 3057 <br />UNmd� <br />5=M=555�NMWMM <br />_...... ...�........,,,�.............._..__...,__...�.�.�.�...._.... _ ....._..�...... ..�.�.......w,w,�..............................._....____...., <br />Required Prior to Submittal to Board <br />,�...- _�..........� .. __..........�_.......�_ ....... ........ <br />. ��.....��......... .._ __...�.�.�.�...................... <br />BPW Attorney F-1 Attorney Name <br />Dept. Attorney [ Attorney Name <br />Purchasing <br />Check the A Pr9priat ,_Item YP .l - e <br />ic Professional Serves Agreement Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />n Bid Opening ❑ Bid Award <br />[❑ Quote Opening ❑ Quote Award <br />E] Proposal Opening ❑ C/O & PCA No, <br />[:] Chg. Order, No. ❑ Traffic Control <br />El Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Naive <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 />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />equired Information <br />/br All Submissions <br />Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />E] Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Herman & Goetz, Inc. <br />..,..�_......ww.....w...www�_���� a ......... <br />....................... <br />Yes ......._................... <br />❑ Q If Yes, Approved by Purchasing <br />[❑ No <br />EI MBE Completed E-Verify Form Attached No <br />WBE <br />Erskine Well VariablemFrequencv Drive Installation <br />-.... <br />119-032..._..... ....w. <br />SSDA <br />-1050-460-42.07 <br />$6,175.00 <br />Project CompletionAffidavitfor the installation of a VFD at the Erskine we <br />house alongwith SCADA integration. <br />Orders Onl <br />Increase <br />Decrease <br />Increase <br />% <br />Decrease <br />......w.............. � �,�. <br />Inc- <br />� ............. <br />% <br />Decrease <br />............................. <br />