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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/03/2019 <br />.... �.............. . _......... <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 12/10/2019 Phone Extension 3057 <br />l �qu r d Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing El <br />Check the Appropriate Item ,r p — Requiredfor All Submissions <br />❑ Professional Services Agreement [:J Contract <br />Open Market Contract <br />E] Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />Quote Opening <br />Z Quote Award <br />❑ <br />Proposal Opening <br />C/O & PCA No. <br />Chg. Order, No. <br />❑ Traffic Control <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 />Information <br />�f Proposal <br />Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />E]IPCA <br />0 Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Premiere 1 Construction, Inc. <br />Yes _ If V.............................. <br />�...................... _...... <br />El es, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />❑ WBE ❑ No <br />At -Lame Council Office Renovations <br />119-105 <br />Counci 's Repairs and Maintenance <br />101-0301-411.36-01 <br />--.....�.�.........�..............�......�........ <br />�� �.................... <br />$21,500.00 <br />LumD Sum <br />QRq1uEq iLc.,ct to renovate e istin At Large Council office into 3 saturate <br />offices. <br />._...�...........�� <br />_... ............................ <br />Chao <br />For 1y. <br />� � Orders11 <br />...... ._ .........._ww <br />Amount of <br />Increase $ <br />F] <br />Decrease ($ ) <br />Previous Amount <br />$ mw <br />..�a ....... .. ........N.���..._ � ............ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />. ........ _www ............... <br />( %) <br />New Amount <br />$ <br />_ <br />Increase�%...... <br />.. ....._666 ���������� ........................_...._. <br />Total Percent of Change: <br />Decrease <br />( %) <br />Time Extension Amount: <br />New Completion Date: <br />