Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/16/2019 <br />Department Public <br />Name Z ch Hurst Works <br />BPW Date 09/24/2019 Phone Extension 3057 <br />N.. ml uuuuuuumu vu an, amummm .uo <br />Re uired Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing .......... ...............�......., <br />Check the <br />Item Type --- li" eluared r All Submissions <br />Professional Services Agreement ❑ Contract ElProposal <br />Open Market Contract <br />E] Amendment/Addendum Special Purchase, QPA <br />❑ Bid Opening <br />F Bid Award Req. to Advertise ❑ Title Sheet <br />Quote Opening <br />® Quote Award ❑ Reject Bids/Quotes <br />Ej Proposal Opening <br />❑ C/O & PCA No. [❑ PCA <br />F-1 Chg. Order, No. <br />F-] Traffic Control Resolution <br />[] Other: <br />Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Elite Electrical...LLC.�....,_ ........................................................................................�.�.�.�.�. <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />E] No <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />0 WBE ❑ <br />Project Name <br />315 & 319 W. Jefferson El ------------- �.....m m.... <br />Project Number <br />119-064 Q <br />Funding Source <br />RWDA TIF <br />Account No. <br />324-1050-460-42.02 <br />Amount <br />$42,750.00 <br />Terms of Contract <br />Lump Sum_ <br />Purpose/Description <br />clectrical wor�repa rs tens buildin , <br />— g4ed uote away d for e � :.__ e. at the cas <br />wall. <br />......................... <br />-�..w.w... <br />mm.. For Change Orders Only - <br />Amount of <br />E] <br />Increase $ <br />Decrease .......................................................................................... <br />Previous Amount <br />...................................._............. <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase _ % <br />Total Percent of Change: <br />Decrease %' <br />Time Extension Amount: <br />New Completion Date: <br />