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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/19/19 <br />Department Public <br />Name Becca Plante Works <br />BPW Date 8/27/19 Phone Extension 5998 <br />�rwwnw,w��w�wvn �..... mwi wwwwwwaowowwwwwwwawwwmuwww � mumuuuuuuuuuuuuuuuuwi — <br />�_.. — �.�—.....w. _._ ...................._'_ _.__....... <br />d Prior to Submittal to Board <br />........ ...._ Required �.............. <br />BPW Attorney E] Attorney Name .._.. _... <br />Dept. Attorney ❑ Attorney Name <br />Purchasing] <br />_ Check the rip . romiat Item Tyd)� tired fi)r'All Submissions <br />El Professional Services Agreement ❑ Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />]] Bid Opening ]] Bid Award <br />Quote Opening El Quote Award <br />E] Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. 1 ❑ Traffic Control <br />Other: <br />_......__..p....... <br />. l �.� <br />wl� e�; ��c �t�tl Informaton <br />Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />PCA <br />E] Resolution <br />F] Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Burkhart mSi Systems <br />YesE] If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE/WBE Contractor <br />❑ MBE BE E-Verify Form Attached Nos <br />Project Name <br />Century Center Exterior Signage <br />Project Number <br />l.._._...m., <br />Funding Source <br />.....o�t........_..�............................................................. <br />Hotel <br />el Motel <br />Account No. <br />7304.4.�......��W�w <br />2010.000.0099 <br />Amount <br />Terms of Contract <br />Lump Sum <br />� <br />Purpose/Description <br />Fabricate & install Century Center exterior signage. <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />For d' tiigc Orders 9pl <br />Increase 1.7% <br />Decrease ..............�.�............% <br />