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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date _04/02/2019 <br />Department Public <br />Name Zach :Hurst Works <br />BPW Date 04/09/2019 Phone Extension 3057 <br />........ ....... <br />Required Prior to Submittal to Board <br />BPW Attorney E] Attorney Name <br />Dept. Attorney n Attorney Name <br />Purchasing ❑ <br />Check the Appropti;te Item Type <br />0 Professional Services Agreement ❑ Contract <br />Open Market Contract <br />R <br />Amendment/Addendum <br />F-] <br />Bid Opening <br />[l <br />Bid Award <br />E] <br />Quote Opening <br />E] <br />Quote Award <br />❑ <br />Proposal Opening <br />❑ <br />C/O & PCA No. <br />❑ <br />Chg. Order, No. <br />❑ <br />Traffic Control <br />E] 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 />❑ Req. to Advertise <br />�] Reject Bids/Quotes <br />❑PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Almac-Sotebeer, Inc. <br />Yes If Yes, Approved by Purchasing <br />No <br />�] MBE Completed E-Verify Form Attached El Yes <br />WBE ❑ No <br />Lot 12 US 31 Industrial Park — Asphalt Paving <br />119-026 _..... <br />River West TIF <br />324-1050-460-42.01 <br />Surface as halt for the Shambau h + Sons building on Carbonmiilll_Drive - s <br />Memo <br />For Crane Orders On <br />Amount of 0 Increase $ <br />E] Decrease ($ ) <br />Previous Amount $ <br />................................. <br />Increase % <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />......................... <br />Increase % <br />Total Percent of Change: Decrease ( % <br />Time Extension Amount: ITITITITITmm- <br />New Completion Date: <br />