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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 08/20/2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 08/27/2019 Phone Extension 3057 <br />INNNNPoNNN NMNINWNW'NWNOM iNN.NNM'O.YNPoNNNIINNI I <br />BPW Attorney Attorney Name <br />Dept. Attorney <br />Attorney Name <br />.............. <br />Purchasing <br />......� <br />Check the A��'o riat Item �j mm_.I���yt/r�� or All Submissions ....... .... <br />Professional Services Agreement Contract Proposal <br />❑] <br />Open Market Contract <br />❑ Amendment/Addendum Special Purchase, QPA <br />Bid Opening <br />® Bid Award Req. to Advertise ❑ Title Sheet <br />El Quote Opening <br />❑ Quote Award Reject Bids/Quotes <br />❑ Proposal Opening <br />[:] C/O & PCA No. ❑ PCA <br />[❑ Chg. Order, No. <br />El Traffic Control ❑ Resolution <br />�] Other: <br />E] <br />Ease./Encroach <br />p e �ii eci Information <br />Company or Vendor Name <br />Walsh & Kelp, Inc <br />New Vendor <br />❑ <br />mwm�m _w..........�_..._�__�� <br />YesE] If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />315 & 319 W. Jefferson Exterior Renovations — Division C <br />Project Number <br />119-064, Div. C <br />Funding Source <br />RWDA TIF <br />Account No. <br />324-1050-460-42.02 <br />Amount <br />$45,989.00 <br />Terms of Contract <br />Lump Sum — base bid plus Alternate No. 1 <br />Purpose/Description <br />a_r a�i�&g eepAtK RF Mj2T!u, ALTERNATE No. 1 _ Division C <br />For Change Orders Only <br />Amount ofEl <br />Increase $ <br />A $.. -------- .......)---------------------------------------- .._....... .. .......................... ........................... <br />F] Decrease..... �. ____ <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />% <br />Increase % <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />