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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/4/2019 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 6/11/2019 Phone Extension 5998 <br />�ro� ...... M�/tl�/tl�/tl�/tlUA�IIIMMIIIIIIMM�B� YgNIWIIWWW�PV�W1 yi ,Wy�g�l p�ffm. gryryplmlUNN IVWWNW'WPoWNW� <br />-ket�wlw Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney E] Attorney Name <br />Purchasing <br />Check the Appropriate ItemType ypp -- <br />❑ Professional Services Agreement E] Contract <br />[❑ Open Market Contract <br />E] Amendment/Addendum <br />0 <br />Bid Opening <br />E] Bid Award <br />[:] <br />Quote Opening <br />[ Quote Award <br />❑ Proposal Opening <br />❑I <br />C/O & PCA No. <br />® Chg. Order, No. 2 <br />E <br />Traffic Control <br />El 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 />All Submissions <br />LJ Proposal <br />[] Special Purchase, QPA <br />]❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />E] PCA <br />[] Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Brown & Brown <br />[❑ Yes ❑ If Yes, Approved by Purchasing <br />No <br />E] MBE Completed E-Verify Form Attached Yes <br />[] WBE [� No <br />Bendix Theater Lift at Century Center <br />118-036C <br />Hotel Motel Tax Fund <br />7304.42010.000.0099 <br />Sum <br />um_�P.............�.�.�.�................. -- ___,-, - _................_�_w ������ �........_.................�......... _. <br />Change_order to cover additions in project material and time. <br />....... ...... _ . __......... <br />_ For .. <br />Amount of Increase $ 1,828.81 <br />Decrease <br />Previous Amount <br />$ 80 850.77 <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ 82,C"79.58 <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />n/a <br />New Completion Date: <br />6/13/2019 <br />