Project Completion Affidavit - Century Center Mezzanine Project No 118-036R - R Yoder Construction Inc

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 6/24/2019 Name T.oy Villa ............................._. ...............�.�.�.� ....�� Department:.......... Eng.neering........w�� ,,,,,.._.._................ BPW Date 07/09/2019 Phone Extension 5920 iwuw�uuw��wwww!mmmi��w��w� wuuuuuH ......,�^� u�.��^tt,�..� --, u,��rvs��muuuuuuumuwmumw�wimwwwwwwwwu�w�mrra�wr�mvna ,......, rUwrm.wrr mmn��ix� Required Prior to Subm ittal mittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney E Attorney Name Purchasing El ................. _............... .... _._.. ___.._.-�....— Check the Appropriate Item Type — Required for All Submissions H Professional Services Agreement L_, Contract ❑ Open Market Contract Amendment/Addendum Bid Opening Bid Award ❑ Quote Opening EJ Quote Award ❑ Proposal Opening C/O & PCA No. n Chg. Order, No. ❑ Traffic Control F� Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description Information LI Proposal E] Special Purchase, QPA Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes PCA Resolution Ease./Encroach R. Yoder Construction, Inc Yes 0 If Yes Approved by Purchasing ® No ❑� MBE Completed E-Verify Form Attached No WBE Century Center Storage Mezzanine 118-036E Hotel Motel Tax Fund 73 04.42010.000.0099 $104,243.5 ProJc0' 'loscout. _............................... _ ... _____ ....... _............. ...._ For'Clian,p Orders Only Amount of Increase $ _ _.__..e Decrease �._$...� _._. �.....�� Previous Amount $ .............. Increase �.............................._..........w�................w�,.. % Current Percent of Change: Decrease ( %) New Amount $ Increase % Total Percent of Change: Decrease Time Extension Amount: New Completion Date: