Project Completion Affidavit - JMS Building Parking Lot Improvements Project No 118-003R - Milestone Fence LLC

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM ate 20 2019�___�_�.W_. ..�...................... Name Toy Villa Department: Engineering BPW Date 08/27/2019 Phone Extension 5920 W o Required Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney [l Attorney Name Purchasing 1:1 Check the ❑ Professional ITServices Agreement ❑ Contract ❑ Open Market Contract Amendment/Addendum Bid Opening F-� Bid Award Quote Opening El Quote Award E Proposal Opening ❑ C/O & PCA No. ❑ Chg. Order, No. ❑ Traffic Control Other. Required Informatior Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description P.T Proposal �] Special Purchase, QPA Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ® PCA ❑ Resolution Ease./Encroach Milestone Fence LLC ❑ Yes( If Yes, Approved by Purchasing [� No MBE Completed E-Verify Form Attached ❑ Yes FIWBE ❑ No JMS Building — Parking Lot Improvements 118-003 River West TIF ..........................___ __ 324 .10503.460.42.02 10503.460.42.02 $85,831.00 Project Closeout m. ...:: .._...... _mWw _..: For, Chagg, Orders Only.... Amount of Increase $ Decrease ($ ) Previous Amount _.....� .�........� $ Increase % Current Percent of Change: Decrease(��% �6... ........_ New Amount $ -- °.............. Increase /o ...........................� _...........� Total Percent of Change: Decrease Time Extension Amount: New Completion Date: ............. _....._..............................................................m_..�A...............................__.