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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/14/19 ........._................... .__..._.___ ...w <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 10/22/19 Phone Extension 5998 <br />Requzred Prior to Submittal to Board <br />... ......... m_....... _ ............ <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />_._ _ _�....saons <br />Check the AfapxITop t Item Tie lice i/ r All Submissions <br />F-J Professional Services Agreement E] Contract ❑ Proposal <br />Open Market Contract ❑ Amendment/Addendum Special Purchase, QPA <br />E] Bid Opening ❑ Bid Award El Req. to Advertise <br />E] Quote Opening E] Quote Award ® Reject Bids/Quotes <br />Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control Resolution <br />Other: Ease./Encroach <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 />I� qu rcd information <br />❑ Title Sheet <br />❑ Yes n If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Century Center North Restroom Renovation <br />Lump mmSum <br />................ �............................ ........ <br />_Upgrades and renovations to the north passenger elevator in the Century <br />Center. <br />_W...... <br />........_._.... <br />For ')fie Orders Only <br />...__ <br />Amount of ❑ <br />Increase <br />El <br />Decrease <br />Previous Amount <br />.$ ............ ...!..... ... <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease:. <br />New Amount <br />$ <br />._ ...%mmmmmmmmmmmmmmmmmm .. . <br />Increase <br />__.� � ..�._........................_ <br />-------..� -...� ..... �� <br />Total Percent of Change: <br />Decrease <br />_.� W .. ...... <br />%) <br />Time Extension Amount: <br />New Completion Date: <br />���� � <br />......._................................_ ................ �_.....���. ..__ <br />