Project Completion Affidavit - Small Drainage Design and Repair Div C Project No 118-063 - Walsh & Kelly

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/13/2019 �w�......_ Name "I'o Villa Department Engineering BPW Date 08/27/2019 Phone Extension 5920 ��nwu�smmmmRm inn i��ou�ua� mnmmm�mrm � Renred Prior to Submittal to Board BPW Attorney Ej Attorney Name ��/��IT�ITITITITITITmmmuWWWWW ITITITITITITIT Dept. Attorney ❑ Attorney Name ._._. ��w�_...w�._... Purchasing Check the ,pEop ke Item IIT pe net uir �] Professional Services Agreement E] Contract Open Market Contract ❑ Amendment/Addendum EI Bid Opening ❑ Bid Award ❑ Quote Opening ❑ Quote Award ❑ Proposal Opening C/O & PCA No. El Chg. Order, No. E] 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 Or All Submissions F]Proposal Special Purchase, QPA Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ® PCA �] Resolution Ease./Encroach Walsh & Kell , Inc. Yes If Yes, Approved by Purchasing ❑ No ❑MBE Completed E-Verify Form Attached No WBE Small Draina e Desi mmm.and Repair 118-063 UtilitExense/Contractual.S...e...r..... Service Fund 251.0608.431.42.96 "r iect Closeout ......� ww�w m..�,. _. ...... For Change Orders Only ...::....w.a � � ......._ _..... �..... �.._ .. ._...... Amount of ❑ Increa�............ se $ ❑ Decrease Previous Amount $._....�.. Increase /o Current Percent of Change: Decrease w %) New Amount $._.��_... ..................�.�_�_�.�..........ow_...........��...._......................._..... Increase .......................... . /o Total Percent of Change: Decrease /o Time Extension Amount: New Completion Date: