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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/2/19 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 3/12/19 Phone Extension 5998 <br />a�ird Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing F , <br />the Appropriate item Type i <br />El Professional Services Agreement ❑ Contract <br />n <br />Open Market Contract <br />❑ <br />Amendment/Addendum <br />E] <br />Bid Opening <br />Bid Award <br />n <br />Quote Opening <br />Z <br />Quote Award <br />E ] <br />Proposal Opening <br />C/O & PCA No. <br />❑ <br />Chg. Order, No. <br />Traffic Control <br />LJ Other: <br />Rena aimed Information <br />Submissions <br />Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />EI Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name Peerless Midwest <br />New Vendor ❑ Yes[:] If Yes, Approved by Purchasing <br />® No <br />MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached Yes <br />❑ No <br />Project Name Cleveland Well Field Refurbishments — Program Related Items <br />Project Number 118-021A <br />Funding Source Riverwe st TIF <br />Account No. �-IT���j�-quo' 1-0& <br />__._ ....... ............ <br />Amount $136,850.00 <br />Terms of Contract Lump Sum <br />Purpose/Description .. ._..._._...._ ...........................�.. <br />Award uote for replacing and inte ratin , progam related items at the Nort <br />and South Cleveland Well Fields. <br />For �,� e Orders h� , <br />❑ Increase <br />$ <br />Amount of -------------.. -.......— <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( <br />New Amount $ ...... %. <br />Increase % <br />Total Percent of Change: Decrease % <br />Time Extension Amount: <br />New Completion Date: <br />