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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/19/18 ._... ........................_ <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 2/26/18 Phone Extension 5998 <br />n � re�rw�wnm�nreu� m^�wwur�mu� omomomomomomomommmwttauiuuaxrcmax� <br />------------ <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney EJ Attorney Name <br />Purchasing [� <br />Check the A ppr opri ate Item Type -- <br />❑ Professional Services Agreement ❑ Contract <br />❑ Open Market Contract <br />Amendment/Addendum <br />❑ Bid Opening <br />Bid Award <br />O Quote Opening <br />® Quote Award <br />❑ Proposal Opening <br />F C/O & PCA No. <br />❑ Chg. Order, No. <br />E] Traffic Control <br />El 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 />E] Req. to Advertise <br />❑ Reject Bids/Quotes <br />[ ] PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Burkhart Si ngSystems .. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />[-1 No <br />E] MBE Completed E-Verify Form Attached El Nos <br />WBE <br />Century Center Exterior Signage <br />118-035B <br />Hotel _Motel <br />0�09�9..................�... �........... <br />7304.42010.000. _.....__....,� .� .�.�.�.�.�.�........... <br />Lum Sum <br />Fabricate & install Century Center exterior signage. <br />For Change Orders Only <br />Amount of Increase $ ...... m <br />❑ Decrease ($ ) _. <br />Previous Amount <br />$ <br />Increase ��������..........��%.�.. <br />_�__.........w�__... <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />