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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/06/2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 05/14/2019 Phone Extension 3057 <br />UNON/AYA M' INHBO W.tiNP. MH pp <br />Repirdd Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the <br />ate Item Type . efir! d or All Submissions <br />Professional Services Agreement [I Contract <br />Open Market Contract <br />0 Amendment/Addendum <br />❑ Bid Opening <br />F-1 Bid Award <br />Quote Opening <br />E] Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />Traffic Control <br />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 />Proposal <br />LJ Special Purchase, QPA <br />❑ Req. to Advertise <br />(] Reject Bids/Quotes <br />PCA <br />F-] Resolution <br />Ease./Encroach <br />Yes LJ If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />[� MBE Completed E-Verify Form Attached El Yes <br />]' WBE No <br />Brick Rd. Pavement Improvements Cleveland Rd/ u.......... <br />119-045 <br />RWDA, j subect to RDC approval <br />......... r .... <br />324-1050-460-31.02 <br />$17,600 <br />Lump Sum Contract <br />Dcsi Li services for pavement re lacement on (,levcland/BricLk lead_, near tli <br />brj over the US 31 By Pass near the Portage Prairie developMgnt. <br />For Change <br />Orders Only <br />.m ............. <br />Amount of <br />m .... <br />_ <br />Increase $ <br />_.... <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />/o <br />Current Percent of Change: <br />Decrease <br />/o <br />New Amount <br />$ <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />%�) <br />Time Extension Amount: <br />.............................. N._w_............... _................... <br />New Completion Date: <br />