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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2-13-2020 <br />Utilities <br />Name inn 'I"Isom )sort <br />BPW Date 2-25-2020 Phone Extension 5969 <br />Review and Approval uired Prior to Submittal to Board W <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />...... <br />BPW Attorney Attorney Name Cleat a McD niels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing E <br />Check the A <br />to r ate Item Tie .l e i <br />E Professional Services Agreement <br />[:] Contract <br />F-1 Open Market Contract <br />® Amendment/Addendum <br />❑ Bid Opening <br />F-1 Bid Award <br />Quote Opening <br />❑ Quote Award <br />I❑ <br />Proposal Opening <br />C/O & PCA No. <br />R <br />Chg. Order, No. <br />Traffic Control <br />F Other: <br />Information <br />Company or Vendor Name SysteLna and Software <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 />Amount of <br />Previous Amount <br />All Submissions <br />LJ Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Yes" If Yes, Approved by Purchasing <br />No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Enquesta CIS Implementation <br />Water O&M Other Contractual Services <br />62096406573135 - <br />$257,800.00 <br />Add additional resources and extend the project <br />timeline <br />❑ Increase <br />]' Decrease <br />Current Percent of Change: <br />New Amount <br />is <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease m(m ....._ <br />Time Extension Amount:. <br />New Completion Date: __....... _.......... <br />