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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/15/19 <br />Name Alicia Czarnecki Department En ineerin <br />BPW Date 05/28/19 Phone Extension 5903 <br />Vie( aired Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney F-1 Attorney Name <br />Purchasing <br />Check the A, propriate Item Type — e(, t.4ir ed fibl" All Submissions <br />_. � .......... <br />Professional Services Agreement ❑ Contract Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum E] Special Purchase, QPA <br />❑ Bid Opening <br />El Bid Award F-1 Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />E Quote Award E] Reject Bids/Quotes <br />Proposal Opening <br />[:] C/O & PCA No. ❑ PCA <br />Chg. Order, No. <br />❑ Traffic Control ❑ Resolution <br />El Other: <br />Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Ziolkowski Construction„ Inc. <br />New Vendor <br />Yes If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑ Yes <br />WBE ❑ No <br />Project Name <br />Morris Performin Arts Center Joint Resealin <br />Project Number <br />....... ......... <br />119-050 <br />Funding Source <br />Morris Performin Arts Center Capital <br />Account No. <br />416.0404.453.36.01 <br />Amount <br />$13,726.00 <br />Terms of Contract <br />........... ........ <br />Purpose/Description <br />_._._. ....... <br />Reseal horizontal and vertical joints on West side of building fagade. <br />For ChangOrders Only <br />Amount of ❑ <br />❑ <br />Increase $ <br />Decrease ($ ) <br />Previous Amount <br />$ _..............WW <br />Increase % <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ <br />Increase % ......__.___._ ._..._.__ ._........� <br />Total Percent of Change: <br />......... _ ..................... <br />Decrease (_ %) <br />Time Extension Amount: <br />New Completion Date: <br />__................... __M .... ....... <br />