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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/03/2019 <br />Name Toy Villa <br />Department: Engineering <br />BPW Date 09/10/2019 Phone Extension 5920 <br />malmmm omomomomo�muwwrorn svcnIDm�moremax wIDne u+ mmmmsm>�mu��>m�,�um�nnomomomomomomomomowwwomomomomomomomomomtomomomomomomomommmmmmwmmuenervmmmw�iun�a mmmmmmmmmmmmmmmmmmuuuuuuuuuumn ifffeu& <br />.�.�. _....�..._._. ..,.... ._....__.�,....__........ _...... --- _............. ..._._...,.—......._......... .�.�.�.�.... m .....m... ...._.� .... Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />. ................�_...._..�.......w .. �.......� <br />Check the nnror�rr`ate Item ` we . l.Rt'Subm t"tuitwd l a• All issions <br />L Professional Services Agreement IL Contract <br />R <br />Open Market Contract <br />Amendment/Addendum <br />E] <br />Bid Opening <br />Bid Award <br />Quote Opening <br />E] Quote Award <br />❑ <br />Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <br />Other: <br />eauired Information <br />Company or Vendor Name Sel e�Construction Co., Inc. <br />LJ Proposal <br />E] Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Yes If Yes, Approved by Purchasing <br />New Vendor <br />Z No <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached � Nos <br />Project Name <br />d Charles Martin Sr. Dr. Improvements <br />Lincolnway West an _....... <br />Project Number <br />117-072A <br />Funding Source <br />RWDA <br />AccountNo. <br />324.1050.460.42.0.3.........._............................................................................................................................................__...__________a�w� .,�a <br />Amount <br />$1,197,648.10 <br />Terms of Contract <br />Purpose/Description <br />Project Closeout <br />For Change Orders Only <br />Amount of 1:1 <br />Increase <br />El <br />Decrease <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease %) <br />New Amount <br />...... ..- m...- - - m................................_............w <br />Increase % .... <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />..... __... � —.. <br />New Completion Date: <br />