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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/19/2019 <br />Name Toy Villa Department hn�� <br />BPW Date 11/26/2019 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the ADDroDriate Item Tvne <br />Professional Services Agreement LJ Contract <br />E] <br />Open Market Contract <br />Amendment/Addendum <br />❑ <br />Bid Opening <br />[ <br />Bid Award <br />Quote Opening <br />Quote Award <br />Proposal Opening <br />C/O & PCA No. I (final) <br />Chg. Order, No. <br />Traffic Control <br />F 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 />Pu se/Descri is <br />Amount of <br />Previous Amount <br />All Submissions <br />H Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />❑ Resolution <br />Ease./Encroach <br />Premium Concrete Services, Inc. <br />............. <br />........ <br />. <br />E] Yes[] If Yes, Approved by Purchasing <br />Z No <br />MBE Completed E-Verify Form Attached <br />❑ WBE <br />2019 Curb & Sidewalk Construction <br />.......... <br />119-004 (Division D2) <br />MVH <br />------------- <br />202.0619.431.31.06 <br />Project Closeout <br />For Chtt <br />El Increase $ <br />..... ................ <br />M Decrease $ 3,015.1 <br />$ 42,124.00 <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />% <br />Decrease <br />7.16%) <br />$ 3. <br />Increase <br />% <br />Decrease <br />(7.16%) <br />❑ Title Sheet <br />Yes <br />[] No <br />