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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name I"c V1ll1 <br />...08d� <br />Department Engineering <br />BPW Date 08/27/2019 Phone Extension 5920 <br />mmmmorwnnww��)nna nn iwmmwiwunnrewnnrnrnrnrrtvw row N imi�.......... °.. �ui�w um <br />Required to Submittal to Board <br />::..�._�._. .._ ._ _ .......w.. <br />BPW Attorney F] Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing ❑ <br />.... ...... . ....... . ..... <br />Check the ?Iygp ate I'tl � em e l kg ! (/ Lo f All Submissions <br />(❑ Professional Services Agreement ❑ Contract 1:1 Proposal <br />❑ Open Market Contract <br />❑ Bid Opening <br />] Quote Opening <br />E] Proposal Opening <br />Chg. Order, No. <br />Other: <br />❑ Amendment/Addendum E] Special Purchase, QPA <br />Bid Award R Req. to Advertise ❑ Title Sheet <br />Quote Award E] Reject Bids/Quotes <br />[❑ C/O & PCA No. ® PCA <br />❑ Traffic Control ❑ Resolution <br />Information <br />Ease./Encroach <br />Company or Vendor Name <br />Brown & Brown General Contractors, Inc. <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />rX] No <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ No <br />❑' WBE <br />Project Name <br />Center Center Lower Level Restroom Remodel <br />Project Number <br />118-082A <br />Funding Source <br />Liability Insurance� <br />Account No. <br />226.0419.672.43.02 <br />Amount <br />$252,070.61 <br />Terms of Contract <br />Purpose/Description <br />Project Closeout <br />oseout <br />_...m,.. <br />..... For mChang Orders Only __ ... <br />Amount of <br />Increase $... mmmmm ....._ <br />�] <br />Decrease t$ 1 <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />% <br />New Amount <br />$ <br />Increase <br />/o <br />Total Percent of Change: <br />Decrease <br />% <br />Time Extension Amount: <br />New Completion Date: <br />