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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/05/2019 <br />Department Public <br />Name Zach Hurst Works <br />............ BPW Date 11/12/2019 Phone Extension 3057 <br />. . . . . . . .. . . . . . . . . ............... . ..... <br />Required Prior to Submittal to Board <br />BPW Attorney F-I Attorney Name <br />Dept. Attorney 0 Attorney Name <br />Purchasing 1:1 <br />Check the Appropriate Item Type — 1?q'quiredJb)- All Submissions <br />Professional Services Agreement [J Contract L] Proposal <br />Open Market Contract El Amendment/Addendum ❑ Special Purchase, QPA <br />F-1 Bid Opening F Bid Award Req. to Advertise El Title Sheet <br />Quote Opening Z Quote Award E] Reject Bids/Quotes <br />Proposal Opening F C/O & PCA No. [:] PCA <br />EJ Chg. Order, No. E] Traffic Control F] Resolution <br />Dot 0 Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />HomeWorks Construction, Inc. <br />...... ............... --- <br />Yes 0 If Yes, Approved by Purchasing <br />. . ........ <br />New Vendor <br />No <br />MBECompleted <br />MBEAVBE Contractor <br />E-Verify Form Attached <br />WBE <br />Nos <br />Project Name <br />Lafayette Building Cleanout <br />Project Number <br />119-098 <br />. ............... <br />Funding Source <br />..................... <br />RWDA TIF <br />... ....................... <br />Account No. <br />324-1050-460-42.02 <br />........... <br />Amount <br />0.00 <br />Terms of Contract <br />......................... . .................... ...... <br />Lump Sum <br />......................... -- . . . . . ........... - . ................................................... <br />Purpose/Description <br />Ouote Project to remove leftover office furniture, debris, <br />and bLQken Liam <br />from the Lafayette Building, <br />....... <br />For Change Orders Only ........... . ............... . ........... <br />. <br />Amount of r-1 <br />increase $ <br />..... . ............ <br />F� <br />Decrease <br />Previous Amount <br />............ <br />$ <br />. .......... .... <br />Increase % <br />................................. <br />Current Percent of Change: <br />. .. . ....... ........................................................... <br />Decrease %) <br />New Amount <br />$ <br />....................... <br />Increase % <br />................... <br />Total Percent of Change: <br />Decrease %) <br />.............. <br />Time Extension Amount: <br />New Completion Date: <br />