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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date May 18, 2020 <br />Department <br />Name Andrea Alexander Wastewater <br />BPW Date MaV 26 2020 Phone Extension 5813 <br />� � �u omomowoamwom ru��mmmm. <br />........... <br />.,�.... ..............._._ .__ .....�.........._.... <br />_....__ <br />Reviewuand A�rval R r�i�°el Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer Officer Name <br />BPW Attorney ZI Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />Purchasing [.� .���..___.�................ <br />Check the Adpr ovr ale Item 'I vne — eauir ,� <br />F] Professional Services Agreement FIContract <br />EJ 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 />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 />LJ Proposal <br />E] Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />E] PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />St. Joseph Comtinty,mmIndiana <br />Yes❑ If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached � Yes <br />F] WBE F-1 No <br />To comply with Agreed Order Case Nos. B-1645 & SW-237 and subsequei <br />Post Closure Plan regarding the Closed Biosolids landfill at the Organic <br />Resource Facility, a new groundwater monitoring well is proposed to be <br />installed on the adjacent County property. <br />Please return two s 1p s of the <br />For Chatige Orders Oily <br />Amount of E] $ Decrease .................. <br />Increase $ <br />Previous Amount $ <br />Increase _...m%.... <br />Current Percent of Change: Decrease ( %) <br />New Amount $ <br />Increasem mmmmmmm % <br />Total Percent of Change: Decrease ( %) <br />