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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/09/19 <br />Name Alicia. Czarnecki Department Engineering <br />BPW Date 10/22/19 Phone Extension 5903— <br />rm�mmmimuuuuuuuuuuuuuuuuuuuuuumvivmmem mmv�rz �uoiom�mmu w �mm , mmNmm 11111uuumwuuimu imrmr.!rr .,: m <br />I.er�ird Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney E:1 Attorney Name <br />Purchasing n <br />Professional Check the ALTpj tgate Item Type Rat, <br />Services Agreement l Contract <br />El Open Market Contract n Amendment/Addendum <br />Bid Opening E, Bid Award <br />Quote Opening [l Quote Award <br />❑ Proposal Opening n C/O & PCA No. <br />E" Chg. Order, No. 1 ❑ Traffic Control <br />�] Other: <br />,Required d 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 Gama Sonic USA, Inc. <br />.❑ Ves [] If Yes, A roved b <br />New Vendor pp y Purchasing <br />No <br />MBE/WBE Contractor MBE WBE Completed E-Verify Form Attached❑ Nos <br />Project Name 2019 Lamppost Lighting Pro ram <br />Project Number 119-006 <br />Funding Source COIT <br />Account No. 404-0602-431.31-06 <br />............... ........ <br />Amount <br />���...m m m ........... �_....... <br />Terms of Contract <br />Purpose/Description <br />Amount of ( LXJ 4 <br />Increase 239.76 <br />Decrease .......�.$........�..� .�......... <br />m............................�.�.�.......�..... <br />Previous Amount $ 47,697.00 <br />Increase ,,,..........g.mg.........._� <br />9% <br />Current Percent of Change: Decrease ( % <br />New Amount $ 51,936.76 <br />Increase 8.89% <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date <br />