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BOARD OF PUBLIC WORKS
<br />AGENDA ITEM REVIEW REQUEST FORM
<br />Date June 180:1 9
<br />Department Public
<br />Name Scott Kreeer _ Works
<br />BPW Date June 25 2019 Phone Extension 9245
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<br />_ required Prior to Submittal to Board__
<br />~ BPW Attorney......._._..__. Attorney Name Clara McDaniel
<br />® Y s
<br />Dept. Attorney Attorney Name
<br />Purchasing Z Michael Schmidt,
<br />_..m__....W__ _..
<br />Check
<br />Agreement o .state Item Type, qu
<br />.. _ ir ed r All Submissions
<br />LJ ProfessionalServicesA gr Contract
<br />E]
<br />Open Market Contract ❑ Amendment/Addendum
<br />E]
<br />Bid Opening ® Bid Award
<br />E]
<br />Quote Opening ❑ Quote Award
<br />Proposal Opening C/O & PCA No.
<br />❑
<br />Chg. Order, No. Traffic Control
<br />El Other:
<br />Required Information
<br />H Proposal
<br />❑ Special Purchase, QPA
<br />E ] Req. to Advertise
<br />F] Reject Bids/Quotes
<br />E] PCA
<br />Resolution
<br />Ease./Encroach
<br />❑ Title Sheet
<br />Company or Vendor Name Klink TrUckmrt Inc.
<br />New Vendor ❑ Yes I If Yes, Approved by Purchasing � No
<br />MBE/WBE Contractor Yes
<br />� MBE Completed E-Verify Form Attached ❑ No
<br />Project Name .......1..0.E 008R Street and Sewer Department Materials
<br />Project Number .�..................... �y �.................�
<br />Streets, Curb & Sidewalk, Sewer Concrete, Sewer Ins, Water Works,
<br />Funding Source Parks
<br />202-0607-431.22-24, .22-30, .22-40, .23-02, .23-03, 23-20, 23-40, .39-89,
<br />641-0621-792.22-24, .23-02, .23-03, .23-04, 202-0619-431.23-03, .23-24,
<br />641-0625-792.22-24, .23-04, 640-0620-811.22-24, .23-04, 620-0640-
<br />m
<br />Account No. ...606.23-30, 201-1101-...45..2.9-89 (Pros Code K61 RMT).3,,.,.�.�........� ,m...................�e �...................._
<br />Amount
<br />Terms of Contract Unit. Pri.ce.....,.__- �.w �....... m_............................. __...
<br />Purpose/Description Open Market award of 2019_aggregate m dfo �aterial bid for the Streets and,
<br />Sewers De a�rtment_
<br />.. _.,_ .._...:
<br />_.-_._.... For Change rders Only
<br />Amount of
<br />Increase $
<br />.. ._ .. ._.....
<br />F]
<br />Decrease
<br />Previous Amount
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<br />$
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<br />��.................%.............
<br />..................�....m�m..............................-.....��.�..........
<br />Current Percent of Change:
<br />Decrease......
<br />New Amount
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<br />Increase
<br />%
<br />Total Change:
<br />Decrease
<br />_
<br />�... �
<br />.�....�...............................�0
<br />Time Extension Amount:�
<br />�,�� � �.�.. .....................W
<br />New Completion Date:
<br />.....
<br />�........ _ m.m A, _..._ ...
<br />
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