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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/22/2019 <br />Name Toy Villa Department: Engineering <br />BPW Date 11/12/2019 Phone Extension 5920 <br />MVNHE MEMNINVNNImIEE MWB,rydir <br />_... ....... ......... w�.....w m-� R���zred. Prior to Submittal to Board.......6 - __......-� <br />BPW Attorney Attorney Name <br />Dept. Attorney <br />Purchasing <br />a <br />0 <br />Check the A <br />Professional Services Agreement <br />U Open Market Contract <br />❑I Bid Opening <br />❑ Quote Opening <br />EJ Proposal Opening <br />[-] Chg. Order, No. <br />F-1 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 />Attorney Name <br />Item Type - <br />Contract <br />❑ Amendment/Addendum <br />Bid Award <br />Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />All Submissions <br />L_J Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />® PCA <br />E] Resolution <br />Ease./Encroach <br />Information <br />Rieth Rely Construction Co., Inc. <br />H Yes U If Yes, Approved by Purchasing <br />No <br />E] MBE E] WBE Completed E-Verify Form Attached ❑ Nos <br />J.C. Lauber Site Improvements <br />118-083B <br />River East Development TIF <br />............... <br />429.1050.460.42.03 <br />$416,367.38 <br />Pro'eet Closeout <br />_.�.� For "hq Orders Only . m-._........ <br />Amount <br />t of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />. <br />Increase .............................. <br />Current Percent of Change: Decrease ( %) <br />New Amount $ <br />........................................._.m........... �... ����_..�.-...............�............. <br />Increase % <br />Total Percent of Change: Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />