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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/3/19 �.�.�........._. _�........._. <br />Department Public <br />Name Becca Plantz......................... �. Works ...............� ........._ <br />BPW Date 9/10/19 Phone Extension 5998 <br />muuuuuummmmuuuuuuuuuuuuuuuuuuuuuuuuuuuuuum�o�mwwmwmu�m�imuwimwwuu �uwdmcewmawnmarmrnr�muv�www.�omommmmmmu�remmmwwwer�mmr�wiw�r.�nrao � � iwmuwrer�wu� umw�wimmmmmmmmmmmuiuiuiuiuwww� <br />Re luired Prior to Submittal to Board <br />_..... _ ............. _.. ..ttalw ........_------ <br />...... <br />BPW Attorney ❑ Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name <br />._.......� �.�...................�.....w ����..._..............._ <br />Purchasing <br />Check the Trial t, Item 'l r ceta <br />mm''tessiona1 Services Agreement ❑ Contract <br />YBi <br />pen Market Contract ElAmendment/Addendum <br />d Opening Bid Award <br />Quote Opening' tart <br />Proposal Opening C/O & PCA No. <br />F-1 Chg. Order, No. ❑ Traffic Control <br />Other: <br />leq�iarcd Information <br />All Submissions <br />❑ Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />J.W. Werntz & Son Inc. <br />.�._.... w ............ <br />❑ Yes❑] If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached No <br />Project Name <br />Century Center Mall Door Repair <br />Project Number <br />118-036D <br />Funding Source <br />Hotel Motel T.�.. _,,,,,,,�...�...�................. � �.... ..... .. �. �.�... <br />ax Fund 2019 <br />Account o <br />10 000.0099 <br />Amount <br />$574 d 00 <br />Terms of Contract <br />Lump Sum <br />m <br />Purpose/Description <br />Rgpair of the Mall Door at the Centiir Center. <br />w ..................�.......m. w�...�� <br />W_ <br />F�or Chan Orders Only, <br />_.. <br />Amount of <br />Increase w $ <br />R <br />Decrease ($ <br />Previous Amount <br />$ ..�.�__ �.� <br />Increase...._ ..�..�....�... ... .............. �... <br />Current Percent of Change: <br />Decrease %) <br />New Amount <br />$ <br />Increase % <br />.... <br />Total Percent of Change: <br />�.�...... mm_ <br />Decrease %) <br />Time Extension Amount: <br />� _, <br />New Completion Date: <br />.............. �........ ... .._.. ... ....... <br />