Notice of Intent - Self Perform Curb and Sidewalk Work

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Aril 12 2019 Name Kara Boyles Department ILmn gib BPW Date Aril 23 2019 Phone Extension 5933 Required Prior to Submittal to Board BPW Attorney ® Attorney Name Dept. Attorney ® Attorney Name Purchasing Check the A fro rlt Item "` e ® All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract 0 Amendment/Addendum ❑ Special Purchase, QPA Fj Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes EProposal Opening C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution ® Other: Public Notice of Intent to Self -Perform Curb and ❑ Ease./Encroach Sidewalk Work feu' fired Information Company or Vendor Name ..... ------ _...__........... Yes If Yes, Approved by Purchasing ................ New Vendor ❑ No MBE MBE/WBE Contractor � Completed E-Verify Form Attached No Project Name 2019 Annual Curb and Sidewalk Program _. _ _ _.. ............ Project Number n/a Funding Source ..-._ ........ ........... ............ Account No. ..... ..... __.................. __......_u.. n/a ...._.. Amount ................... n/a _....._.. Terms of Contract ..... ......... ._ .................... n/a ................ Purpose/Description ...... _...._ ..._. ............. Notice of intent to self erform work using City forces for ........................... projects greater than $100,000. For%bra ` Amount of F-1 Increase $ ❑ Decrease ($ ) Previous Amount _... - ................ ........ $ Current Percent of Change:. New Amount Increase % Decrease ( % Increase % Total Percent of Change: Decrease ( % Time Extension Amount: New Completion Date: