Project Completion Affidavit - Bendix Theater Lift at Century Center Project No 118-036C - Brown & Brown

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 8/13/2019 Department Name Tov Villa �..� Engineering �....._-- �........................._�.�.�.�... BPW Date 8/27/2019 Phone Extension 5920 _..._. .........� �.. l.oguird Prior to Submittal to Board .._._.. .......... BPW Attorney Attorney Name Dept. Attorney E] Attorney Name Purchasing ❑ Check the Appropriate Item T ,� 1 �� r . _..-.:............................ww_ . Professional Services Agreement ]J Contract Open Market Contract Amendment/Addendum Bid Opening Bid Award ❑ Quote Opening Quote Award ❑ Proposal Opening C/O & PCA No. E] 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 Information All Submissions Proposal (] Special Purchase, QPA ❑ Req. to Advertise E] Reject Bids/Quotes N PCA E] Resolution Ease./Encroach Brown & Brown General Contractors, Inc. Yes❑ If Yes Apmmmrovedb Purchasing ® No ❑ MBE Completed E-Verify Form Attached ❑ WBE Century Center Ben.......X...T.........�...._...._...........eater- ................Liftat C....�66 . ........ 118-036C Hotel... Motel ... Tax ... F.......................................................... �.,,,, _ _ and 7304.42010.000.0099 $82,679.58 P rc -qq closeout. ❑ Title Sheet ❑ Yes ❑ No Amount of ......_..w_ _ ....... For Chan -Orders Only_ _... �] Increase $.....� .. � � ------ --- Decrease $ )................................................. Previous Amount $ Current Percent of Change: New Amount Total Percent of Change:. Time Extension Amount: New Completion Date: Increase % Decrease ( % Increase % _ Decrease ( %