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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/03/2019..........................................ww_........ <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 12/10/2019 Phone Extension 3057 <br />woo <br />............_._.....-_......_.__..._-luuired Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney EJ Attorney Name <br />Purchasing F <br />Check the <br />Professional Services Agreement <br />L J!, Open Market Contract <br />0 Bid Opening <br />E Quote Opening <br />0 Proposal Opening <br />® Chg. Order, No. 1 <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 />[tp Item "1` ae ._......... ...__..— <br />Contract <br />❑ Amendment/Addendum <br />❑ Bid Award <br />E] Quote Award <br />C/O & PCA No. <br />Traffic Control <br />Information <br />All Submissions <br />Proposal <br />LJ Special Purchase, QPA <br />❑ Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />FResolution <br />F-1' Ease./Encroach <br />❑ Title Sheet <br />Ziolkowski Constniction Inc. <br />............................... _.. ..................... ..... _m <br />es If Yes, Approved by Purchasing <br />® No <br />0 MBE <br />❑ WBE Completed E-Verify Form Attached E] Nos <br />315 & 319 W. Jefferson Exterior Renovations — Division B <br />119-064. Div. B <br />RWDA TIF <br />324-1050-460-42.02 <br />$24,798.00 <br />Lump Sum <br />lian ,e order` l"or Masonr Rc airs Division B) due to unforeseen condition <br />— see attached memo. <br />...... <br />For Cltaii ,e Orders Onlm.... <br />Increase $ 24,798.00 <br />Amount of <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ 39,574.00 <br />w „o............................. <br />Increase 62.66/o........._.�_.............._.__�.� <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ 64,372.00 <br />Increase 62.66% <br />w— <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />._.�._._. — w �� ........_. __..._......... .... ._ .....�. <br />