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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January° 21, 2020 <br />Department <br />Name Alicia Czarnecki Engineering/Fire <br />BPW Date JanuarX 28219 Phone Extension 5903 <br />Review and A roval Re uim' Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />BPW Attorney [ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />INI <br />Check the <br />ro dale Item "1 �° ii <br />Professional Services Agreement <br />R Contract <br />El <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />® Quote Opening <br />® Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />Other: <br />Reuured Information <br />All Submissions <br />❑ Proposal <br />EJ Special Purchase, QPA <br />Req. to Advertise ❑ Title Sheet <br />Reject Bids/Quotes <br />F] PCA <br />❑ Resolution <br />Ease./Encroach <br />Company or Vendor Name <br />TBD <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />No <br />Yes <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached <br />BE No <br />Project Name <br />Fire Stations 3 & 6 Abatement Quote <br />- ����� �--.��....._- ._� �� _... _.�........... <br />Project Number <br />118-047A <br />Funding Source <br />FIRE PROFESSIONALWSERVICES / OTHER PROFESSIONAL SVCS <br />..............................� ww <br />Account No. <br />��._....._.�... <br />101-0901-422.31-06 <br />Amount <br />TBD <br />Terms of Contract <br />.............................. ... .w... <br />NT_E <br />Purpose/Description <br />Remove and dispose of asbestos floor tile and black mastic in identified <br />locations at Fire Station 3 & 6. <br />Amount of Increase ...$..... _wm------w <br />�] Decrease <br />Previous Amount $ <br />.............................................. <br />Incw ......www ... <br />rease % <br />_.......... <br />Current Percent of Change: Decrease - IT mmmmmmmmm mmmm% <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ( %) _W.. w.. <br />Time Extension Amount: <br />New Completion Date: <br />