Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/25/19 <br />Name Alicia Czarnecki Department Engineering <br />.... .. _........... <br />BPW Date 05/14/19 Phone Extension 5903 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Tyl e, <br />H Professional Services Agreement ❑ Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />0' Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />Quote Award <br />Proposal Opening <br />F-1 <br />C/O & PCA No. <br />E] <br />Chg. Order, No. <br />[] <br />Traffic Control <br />F-1 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 />Amount of <br />Previous Amount <br />Information <br />All Submissions <br />Proposal <br />Special Purchase, QPA <br />® Req. to Advertise Title Sheet <br />❑ Reject Bids/Quotes <br />I-1 PCA <br />Resolution <br />Ease./Encroach <br />..P......�n..................... <br />If Yes, pprovedburchYe..____.... <br />No <br />MBECompleted E-Verify Form Attached ❑ Nos <br />Muessel Grove Public Restroom <br />118-099 <br />VPA Capital <br />416.0404.453.36.01 <br />Public Restroom renovation at Muessel Grove Park to restore functionalit <br />and meet all a licable state and 1 deral code re uirements. <br />❑ Increase <br />Decrease <br />Current Percent of Change: <br />New Amount <br />For Change Orders <br />Increase % <br />Decrease ( % <br />Increase <br />Total Percent of Change: Decrease (............. %) <br />Time Extension Amount: <br />New Completion Date: <br />MAY <br />