Project Completion Affidavit - St Joseph Street Improvements Project No 118-008 - Walsh & Kelly

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 08/0 9/201 9 Name Toy Villa Department: Engineering BPW Date 08/27/2019 Phone Extension 5920 mm»mmu mmmmomommomwmy= mmmmw mrim ar HE mnmar ..,.,.,.,.._..�._.�............._.......,..�..._.�_—.........�... _..... ........... 11 i edITPrior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing Check the Amiroonate Item " oe -. k.J Professional Services Agreement LJ Contract ] Open Market Contract ❑ Amendment/Addendum Bid Opening ❑ Bid Award E] Quote Opening ❑ Quote Award Proposal Opening R C/O & PCA No. Chg. Order, No. ] Traffic Control F-1 Other: Information Company or Vendor Name Walsh & belly, Inc. New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description All Submissions ❑ Proposal ❑ Special Purchase, QPA 0 Req. to Advertise ❑ Title Sheet ❑ Reject Bids/Quotes ® PCA E] Resolution Ease./Encroach Yesl If Yes, Approved by Purchasing No MBE ❑ WBE Completed E-Verify Form Attached ❑ Nos St. Joseph Street Improvements 118-008 SouthSide Development TIF................................��..........................m_..............�.�.�................_. 430.1050.460.42.02 $449,436.52 Project Closeout .......... For C1 � ng Orders O ld Increase Amount of $ Decrease ($ Previous Amount $ Increase % Current Percent of Change: Decrease %) New Amount $ -- .. �_�....._...............w---------_ ._...... Increase_.�......._...._....................................�_ o ° ........................ �. Total Percent of Change: Decrease �, -__� _____.� �_........................... _ �.�...................................................._. Time Extension Amount: New Completion Date: