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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/19/19 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 2/26/19 Phone Extension 5998 <br />® rHva�mwnnmu��rmm�mmuene rei�mwwww�m�nmvfl mmmmmmuuuuuuuuuuummmum�im imimHHmimofimimrc <br />...... .—.. ....... ._._..—_.............. �......�......_ _.... .. <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing � �T��m�mmmmmmmmm <br />Check the Appropriate Item Type <br />LJ Professional Services Agreement ❑ Contract <br />Open Market Contract ❑ Amendment/Addendum <br />EJ <br />Bid Opening ® Bid Award <br />Quote Opening ❑ Quote Award <br />E] <br />Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. ❑ 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 />Special Purchase, QPA <br />E' Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />E] Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Peerless Midwest <br />Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />MBECompleted E-Verify Form Attached Nos <br />North Station Well No. 1 Replacement <br />117-031 R <br />�ww <br />Water Works <br />$532,,763.00 <br />Lump Sum <br />Award bid for the replacement of Well Number 1 at North Station. <br />._ _ . __. <br />For Chan ;e Orders Only <br />.... _....... ... <br />Amount of Increase $ <br />_. _.. <br />[� Decrease �$ ) <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease (` % <br />Increase % <br />Decrease ( % <br />