Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date March 18 2019 <br />Name Alicia Czarnecki Department Engineering/Fire <br />BPW Date March 20 2019 Phone Extension 5903 <br />WIWNlMM1YIPVPo NNNN@N@W N!4�Mgq!M � R I/WA/A4lfP.A�dIOfmYnIAF.'�'8 � �f�Zp9pAM �.. <br />_ R ui:�•ed Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Elliot Anderson <br />Purchasing <br />Check the Appropriate Item,Type <br />Professional Services Agreement Contract <br />E] Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />[:] Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />F-1 C/O & PCA No. <br />❑ Chg. Order, No. <br />F-] Traffic Control <br />F—J Other: <br />Company or Vendor Name Shive- <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 />F ' Special Purchase, QPA <br />R Req. to Advertise <br />❑ Reject Bids/Quotes <br />] PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />LJ YesLJ If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />Fire Station 6 Second Floor Remodel / Fire Station 3 Renovation <br />73 <br />$6,750.00 <br />NTE <br />Study_and Report for predesign studies for the South Bend Fire Stations 3 <br />and 6. <br />._ ._:.....� �.�. . <br />For Change Orders Qo1 <br />..Increase _ <br />Amount of $m _. ..... ............. a <br />Decrease ($ )... <br />Previous Amount <br />$ <br />_ <br />Increase <br />Current Percent of Change: <br />Decrease <br />(% <br />New Amount <br />$ <br />Increase <br />Total Percent of Change: <br />Decrease <br />_.......... <br />Time Extension Amount:. <br />New Completion Date: <br />