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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />December 5, 2017 <br />Kara Boyles <br />Department <br />Division/Bureau <br />Engineering <br />DPW <br />BPW Date 12/12/17 Phone Extension 5933 <br />❑ <br />Agreement <br />❑ Contract U Proposal U Addendum <br />❑ <br />Professional Services <br />❑ Resolution <br />❑ Bid Opening <br />® Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ <br />Quote Award <br />❑ <br />Change Order No. <br />❑ <br />CIO & PCA No. ❑ PCA <br />❑ <br />Ease/Encroach. <br />❑ <br />Traffic Control: <br />n <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBEIWBE Contractor <br />MBEIWBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Premium Concrete Services, Inc. <br />❑ Yes ® No ❑ If Yes, Approved <br />F 1 MBE N WBE <br />No ® Yes Name of Company Premium Concrete Services, <br />1.00_Wayne Street Plaza and Streetscape <br />116-047R <br />TIF RWDA - <br />324-1050-460-42.01 <br />$224,110.00 <br />