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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/7/19 <br />Name Becca Plantz <br />Department Public <br />Works <br />BPW Date 5/14/19 Phone Extension 5998 <br />WN991 M"WH NNM.'OA P,!@illl'�W�W�V�VA!'�9iYWUfN%l YNW' N.W 1W/N/H///i5&?5N00/PL///IIflRWIf®d(fN[%d(f(f(f(68%//15ID1WAtl®SYdISISISQHlIl9NMWf:3. U TNf�H9AWl//Nuifldk' f4YU✓AWmiS/ ddklPdN bOF4`Gi 6 W�ikAdIIV41mIIlIWIm� <br />1� uired Prior to Submittal to Board <br />BPW Attorney F-j Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing F <br />Check the App •opr ate Item Type -- Requi ed l w All Submissions <br />Professional Services Agreement ❑ Contract <br />Open Market Contract ❑ Amendment/Addendum <br />E] <br />Bid Opening ❑ Bid Award <br />E <br />Quote Opening EI Quote Award <br />❑ <br />Proposal Opening ❑ C/O & PCA No. <br />® <br />Chg. Order, No. 1 ❑ Traffic Control <br />Other: <br />Company or Vendor Name Peerless Midwest <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 />❑I Proposal <br />E Special Purchase, QPA <br />❑ Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />❑, Resolution <br />Ease./Encroach <br />Yes❑ If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />F❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />Cleveland Well Field Refurbishments — Program Related Items <br />118-021A <br />Riverwest TIF <br />324-1050-460.42-02 <br />Lump Sum <br />Contract sum increase to upgrade touchscreen to different vendor. <br />__................. <br />w For � "lt���m�g� Orders Only mm <br />Amount of <br />Increase $ 3894.00El <br />Decrease$ ) �.. ..........._. <br />Previous Amount <br />$ 136,850.00 .................. <br />Increase 2.85 /o <br />Current Percent of Change: <br />Decrease (n %) <br />New Amount <br />$ 140,744.00 <br />...................... ........ ......... .......... <br />o <br />Increase 2.85 /o <br />Total Percent of Change: <br />Decrease% <br />Time Extension Amount: <br />New Completion Date: <br />