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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 09/27/19 <br />Name Alicia. Czarnec i/Ro ser Na",rot Department E gincr"in <br />BPW Date 10/08/19 Phone Extension 5903 <br />ww niNJNN uimmmommmmmmmmmmMmmmmmmmmuuuuuuuuuuuuuuuuuumumw ww mmnmmnmmnmmnmmn000 �mawar <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney [ Attorney Name <br />Purchasing El <br />Check the App rt Item T eRe <br />Professional Services Agreement F Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />Quote Opening Quote Award <br />Proposal Opening C/O & PCA No. <br />❑ Chg. Order, No. Traffic Control <br />Other: <br />red Information <br />dP-r All Submissions <br />Proposal <br />Special Purchase, QPA <br />[� Req. to Advertise <br />Reject Bids/Quotes <br />[J PCA <br />❑i Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Lochmueller +r rots, lnc. <br />Yes Ye If s, Approved by Purchasing _......._._ <br />New Vendor <br />❑ No <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ Nos <br />❑❑ WBE ❑ <br />Project Name <br />Corby Blvd/Ironwood Drive/ Rockne Drive <br />_........ _ ... _........................ _._.. <br />Project Number <br />116-034 <br />Funding Source <br />LRSA Capitalmm <br />Account No. <br />....... ... ........ <br />251-0608-431.42-96 <br />Amount <br />$406400.00...................�........._.u. <br />Terms of Contract <br />Hourly <br />Purpose/Description <br />Construction Inspectionsfor Corby Blvd/Ironwood Drive/ Rockn e <br />Drive Intersection Improvement. <br />Amount of F-1 <br />Increase $�� <br />Decrease ($ <br />Previous Amount <br />$ <br />Increase <br />Current Percent of Change: <br />Decrease ( % <br />New Amount <br />Increase � <br />Total Percent of Change: <br />Decrease (..� % <br />Time Extension Amount: <br />New Completion Date: <br />