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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/5/2020 <br />Department --- <br />Name <br />DCI <br />BPW Date-I+ebrti.ry 25 <br />2020 <br />Phone Extension 5845 <br />Review and ppr vtt R cq�r i Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer <br />Officer Name <br />M. Patton <br />-.... <br />orne <br />BPW Attorney y . <br />��W_ <br />m.. <br />.... Name.... <br />AttorneyClara <br />Dani <br />McDaniels <br />els <br />Dept. Attorney <br />Attorney Name <br />Sandra Kennedv <br />Purchasing <br />[� <br />Professional Services <br />Agreement <br />Open Market Contract <br />❑ Bid Opening <br />Quote Opening <br />Ej Proposal Opening <br />Chg. Order, No. <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 />ons <br />Contract LJ Proposal <br />Amendment/Addendum <br />❑ Special Purchase, QPA <br />El Bid Award <br />❑ Req. to Advertise ❑ Title Sheei <br />[] Quote Award <br />Reject Bids/Quotes <br />❑ C/O & PCA No. <br />F] PCA <br />❑ Traffic Control <br />E] Resolution <br />El Ease./Encroach <br />R uired Information <br />I'iaga l�l <br />Yes If Yes, Approved by Purchasing <br />❑[D No <br />❑ MBE Completed E-Verify Form Attached Yes <br />❑ WBE E] No <br />Hit 1 i.�wids Counselor <br />�.I lay c c,t, H... <br />......rw <br />StateoGpiscli!M based on Fees „in Exhibit I <br />�..._.° 2t12f „i!cl z 2021__..... <br />J py 1 <br />o provide services those nee l' counseling screenings advice car <br />�T. <br />�1.fternativc solutions related to hoLisi"Atipl�ncf��cl�y nli <br />default <br />� <br />Increase $ <br />Amount of <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: Decrease <br />New Amount $ <br />Total Percent of Change: Increase % <br />