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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/30/19 mmmm <br />Name Alicia Czarnecki/Pani Me e ° Department C n ineeri / DCI <br />BPW Date 11/12/I9 Phone Extension 5903 <br />mmomoMMMNmmow ffl m mffl <br />...�... _. ....w............... <br />lie u�d Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney [] Attorney Name <br />Purchasing <br />.............�..._w...... <br />Check the Appropriate Itemav... Reqy <br />Professional Services Agreement E] Contract <br />Open Market Contract ❑ Amendment/Addendum <br />0 Bid Opening ❑ Bid Award <br />❑ Quote Opening ❑ Quote Award <br />sal Opening C/O <br />PCA <br />❑ Ch . Order, No. 2 ❑ Traaffic Control <br />µ <br />g• ® <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />aired Information <br />All Submissions <br />" Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />0 PCA <br />Resolution <br />0 Ease./Encroach <br />❑ Title Sheet <br />HC3 LLC dba St Clair Development <br />❑ Yes❑ If Yes, Approved by Purchasing <br />H No <br />F1 MBE Completed E-Verify Form Attached ❑ Nos <br />WBE <br />ments <br />510 Main Street Building Improvem s <br />119-084 ........REDIT /Grants &SubRedevelopment General al <br />_.._. .......... <br />408.1001.460.39.30 / 433.1050.460.39.30 <br />See attached summary of change order items due to <br />chanced/unforeseen site conditions. <br />Amount of Increase $ 6,458.50 <br />(� Decrease ($ ) <br />Previous Amount $ 154,704.46 <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change; <br />Time Extension Amount <br />New Completion Date: <br />Increase 4.17% <br />Decrease ( %) <br />$ 161,162.96 <br />Increase 7.81 % <br />Decrease <br />0 days <br />