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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/01/2019 <br />Department Public <br />...Name Toy Villa � Works .... m __..... <br />BPW Date 07/ /2019 Phone Extension 5920 <br />mw � �an�,omxro,�r,�wnmr�rrw ��� ... ax�i��M�m�,..�^ • •m ,.. m. �x� <br />red Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />0 <br />All Submissions <br />Professional Services Agreement JI Contract " Proposal <br />El Open Market Contract ❑ Amendment/Addendum 0 Special Purchase, QPA <br />Bid Opening Bid Award E] Req. to Advertise <br />Quote Opening E] Quote Award 0 Reject Bids/Quotes <br />Proposal Opening] C/O & PCA No. ® PCA <br />❑ Chg. Order, No. Traffic Control ❑ Resolution <br />F-1 Other: F-1 Ease./Encroach <br />Company or Vendor Name Peerless Midwest, Inc. <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 />Yes] If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached <br />❑ WBE <br />Cleveland Well Field Refurbishments — Program <br />118-021A <br />Riverwest TIF <br />$145,244.00 <br />Project Closeout <br />❑ Title Sheet <br />❑ Yes <br />❑ No <br />Related Items <br />w. .....F1�... �............... <br />.or......wCw_wge Orders Only <br />Amount of <br />Increase $ ... _ .... <br />E] Decrease$__m ......_._ w <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease 1' % <br />Increase % <br />Decrease (..........................% <br />