Change Order No 1 - 2019 Small Drainage Project No 119-019A - Selge Construction Co Inc

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 7/10/2019 Department Name Sue Ellen Doudrick Engineering Division BPW Date 7/23/2019 Phone Extension 5922 immumwuwuwuwuwuwuwuwiwuuiN��,rewamroimw�^ � .. vummmmmm�mm�mimimimimwmWmWuuuuw!�!w!wwwuuw�wv�r�uumrrrm!�.�urwr wwiuiuiv^�i��mmm0000immimimimimimmmAo�imuuuuuuuuuuuummmummiuiuiwwwa . , �m�� d Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing 1:1 Check the Appropriate Item Tv - E' Professional Services Agreement ❑I Contract ❑] Open Market Contract ❑ Amendment/Addendum ❑ Bid Opening ❑ Bid Award E] Quote Opening ❑ ,Quote Award Proposal Opening ❑ C/O & PCA No. Chg. Order, No. ❑ Traffic Control E] 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 r All Submissions Proposal ❑ Special Purchase, QPA E] Req. to Advertise [:]' Reject Bids/Quotes PCA Resolution Ease./Encroach ❑ Title Sheet Sel;e Construction .... Yes[] If Yes, Approved by Purchasing ® No [� MBE Completed E-Verify Form Attached El Yes E] WBE ❑ No 2019 Small Drainage (Lathrop) 119 019A Storm Sewer Fund Fund 667 667-062„1„ 792. 2-04 Capital .....t.a Unit Prices See... attached ..memo, For....ire Ordersnl w. Amount of ❑ Increase $ Decrease ($ Previous Amount $ Increase...............................................................w�____ °_/o Current Percent of Change: Decrease ( % New Amount $ ......Increase ............._.... m.m_....................% �...,... �.. �..�� o_..... Total Percent of Change: Decrease /o Time Extension Amount: New Completion Date: