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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/19/2019 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 11/26/19 Phone Extension 5998 <br />�; ��x�•��� Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the AppropriatIternly --.... !Lu <br />Professional Services Agreement ❑ Contract <br />❑ Open Market Contract 0 Amendment/Addendum <br />E] Bid Opening F� Bid Award <br />Quote Opening ® Quote Award <br />[� Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. ❑ 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 />vdfir All Submissions <br />Required , Information <br />" Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />EJ Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Yes L If Yes, Approved by Purchasing <br />[� No <br />❑ MBE Completed E-Verify Form Attached ElYes <br />❑ WBE ❑ No <br />Edison Well #3A Rehabilitation <br />119-097 ...... .___....__.._ ...........� <br />.. .................. ............ <br />Water Works Source of Supply and Other Professional Services <br />.._. .___.. <br />620-0640-602-3106 <br />_....._ ............... <br />$66,900.00 <br />Lum Sum <br />Cle4ningJpMection. and motor replacement of well #3A at the Edison Well <br />Field. <br />... <br />For Chagg�_Orders Only <br />Amount of 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 .....IT..OZO) <br />Time Extension Amount: <br />...................................... .. ........................���� <br />New Completion Date: ......._......__ <br />