Project Completion Affidavit - Human Rights Commission Office Remodel - Premier I Construction

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date June 28, 2019 Name Adam Parsons ..............._. _. ........... Central Services BPW Date duel ° 9 019 Phone Extension 9302 u�so-raRGemrmwwwmm�mns^r^uwnTiu�u�wr��n��,.�.,�»,.,.�,�,t.,,»,!rrr,rum�rni�mar-tmi,rri��w;��mzz!.,;tr.,w�.� � �A ��✓�� mr�uuuuuuuuuuuuuwr;�trr*rkum+er�m��ann�r�e .,��:r�;,�cRvwr�wa rsrrwr�aw��esa,�,mvr_ �r �uare�r+u�ae��arnrid�miwumn _ m... Required Prior to Submittal to B.o..ard ......_._ �. ,��_.m.. . BPW Attorney X Attorney Name Clara McDaniels Dept. Attorney ❑ Attorney Name Purchasing Check the Item l woc . Required t /,• All Submissions Professional Services Agreement ❑ Contract Open Market Contract ❑ Amendment/Addendum E]' Bid Opening ❑ Bid Award E] Quote Opening ❑ Quote Award ❑ Proposal Opening n C/O & PCA No. Chg. Order, No. Traffic Control Other: Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description uired Information Proposal _�w_rww Special Purchase, QPA Req. to Advertise Reject Bids/Quotes PCA Resolution ❑] Ease./Encroach ❑ Title Sheei Premier I Construction Yes .. ....................w. ❑j ❑ If Yes, Approved by Purchasing No ❑ MBE WBE Completed E-Verify Form Attached ! Nos Human Rights Commission — Office Remodel COIT 404-0.�..� .�.�..�.�...�.... 617-631.36-01 Lug... Sum ......................W....... Project Closeout For '",tagyOrders Ord° Amount of El Increase $ Decrease Previous Amount $ Current Percent of Change New Amount Total Percent of Change: Time Extension Amount: New Completion Date: Increase % Decrease _�............_..........�.�.% Increase % .......... Decrease...........