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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 18 2020 <br />Department Utilities — <br />OrBaini Resource <br />Name Andrea Alexander Facilitv <br />BPW Date Februar 25 2020 Phone Extension 5813 <br />�1 <br />...................­.._�.�.�.�.�.�.�.�.�.�.�.�..........................._..__u_.._w..._uu..�. <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name <br />BPW Attorney ® Attorney Name Clara Me.Daniels <br />Dept. Attorney ❑' Attorney Name <br />Purchasing F <br />..... -............ ................ _... <br />� �— <br />Check the Apmonriaie Item <br />jJ Professional Services Agreement " Contract <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />R Quote Opening <br />❑ Quote Award <br />f Proposal Opening <br />❑ C/O & PCA No. <br />❑I Chg. Order, No. <br />❑ 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 />Information <br />All Submissions <br />Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />E] Reject Bids/Quotes <br />0 PCA <br />E] Resolution <br />Ease./Encroach11 <br />❑ Title Sheel <br />Keramida Inc. <br />E] Yes If Yes Approved by Purchasi <br />ng <br />® No <br />❑ MBE Completed E-Verify Form Attached F1 Yes <br />® WBE E] No <br />MW-13 GroundwaterAnalysis <br />wInvesti Investigation &Groundwater Statistical Asis <br />Closed Landfill Monitoring w <br />641-0631-793-6339 <br />21,255 <br />Follow Groundwater Monitoring Plan required by Post -Closure Plan of <br />Biosolids Lagoon #4 <br />For ChangeOrdersmOnly <br />Amount of Increase $ <br />Decrease ($ ) <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />g ........... ___ <br />Total Percent of Change: Decrease % <br />