Project Completion Affidavit - The Garage Site Improvements Proj No 118-083C - R & R Excavating Inc.

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date Name 10/29/2019 Tov Villa Department: Engineering BPW Date 11/12/2019 Phone Extension 5920 Prior Submittal to Board lIe �t�c6Prto S ....._.. _......__._ _..._� ..... BPW Attorney F-1 Attorney Name Dept. Attorney E] Attorney Name Purchasing El Check the Appropriate Item T pe -- eauir &-1 tbi° All Submissions LJ Professional Services Agreement ❑ Contract Open Market Contract EI Amendment/Addendum ❑ Bid Opening [ Bid Award E Quote Opening Quote Award Proposal Opening ❑ C/O & PCA No. ❑ Chg. Order, No. Traffic Control F-1 Other: Hired Information Company or Vendor Name R & R Excavating, Inc. New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description HProposal Special Purchase, QPA EJ Req. to Advertise ❑ Title Sheet Reject Bids/Quotes N1 PCA Resolution Ease./Encroach Yeses If Yes, Approved by Purchasing No ❑ MBE Completed E-Verify Form Attached Yes ❑ WBE ❑ No The Garage Site Improvements 118-083C p F River East Development TI ............ .. 429.1050.460.42.03 . M ... .. _... .... _..................... Projcet Closeout. _.......... _...... _, For Chang Orders Only_ ................._. Amount of ❑ Increase $ _. .............. Decrease ($ ) Previous Amount $ ......... ... ._.... Increase _................... % Current Percent of Change: Decrease.._..... %) New New Amount $ �........................ �_ Increase ................. % Total Percent of Change: Decrease ( /o) Time Extension Amount: New Completion Date: