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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/05/19 <br />Name Alicia Czarnecki. Department En inccrin <br />BPW Date 11/12/19 Phone Extension 5903 <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ❑ <br />"Professional Services Agreement L Contract <br />Open Market Contract <br />Amendment/Addendum <br />❑ Bid Opening <br />Bid Award <br />F-1 Quote Opening <br />Quote Award <br />Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />F Other: <br />Company or Vendor Name <br />U Proposal <br />0 Special Purchase, QPA <br />R Req. to Advertise ❑ Title Sheet <br />.„ Reject Bids/Quotes <br />[� PCA <br />Resolution <br />Ease./Encroach <br />New Vendor U YesU If Yes, Approved by Purchasing <br />❑ No <br />MBE/WBE Contractor F❑ wBE Completed E-Verify Form Attached <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Muessel Grove Public Restroom <br />118-099R ..................._._ <br />VPA Capital <br />.................... <br />416.0404.453.36.01 <br />❑ Yes <br />No <br />Public Restroom renovation at Muessel Grove Park to restore functionalit <br />and meet all a plicable state and federal code requirements, <br />Amount of LJ 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 />..................... ........ _. <br />Time Extension Amount: <br />_.- <br />................... .............. <br />New Completion Date: <br />