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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/17/2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 1249/2019 Phone Extension 3057 .........._..._. <br />imimiMHH111ummmmuuuu i <br />Required d Prior to Submittal to Board <br />BPW Attorney El Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing F <br />Check the A propriate Item '3 ypITIT <br />Professional Services Agreement Contract <br />ElOpen Market Contract <br />® Amendment/Addendum <br />❑ Bid Opening <br />Bid Award <br />El Quote Opening <br />El Quote Award <br />EJ <br />Proposal Opening <br />F-1 C/O & PCA No. <br />F] <br />Chg. Order, No. <br />❑ Traffic Control <br />F-1 Other: <br />All Su miss. <br />ons <br />L_J Proposal <br />Special Purchase, QPA <br />EJ Req. to Advertise <br />EJ Reject Bids/Quotes <br />PCA <br />Resolution <br />El Ease./Encroach <br />❑ Title Sheet <br />__._....... ............ <br />,Rt'M Uil' � Information <br />I,.........._....... <br />Company or Vendor Name <br />Troffer Oros. <br />New Vendor <br />El Yes If Yes, Approved by Purcha11 sing <br />No <br />MBE/WBE Contractor <br />F] WBE Completed E-Verify Form Attached ❑ Nos <br />Project Name <br />Cleveland Rd./Brick Rd. Pavement Improvements <br />Project Number <br />119-045 <br />Funding Source <br />RWDA <br />Account No. <br />...---------------- w-�_....... _.... ....... wm <br />324-1050-460-31.02 <br />Amount <br />_........ ........................ .w� �w <br />$105000 <br />Terms of Contract <br />.. �.................. .......... .�.m <br />Lump Sum Contract <br />Purpose/Description <br />Amend existingPSAmfrom $17.6k to $27.6k to account for utility coordinatil <br />services. <br />__ <br />For Change Orders Only, <br />ww ................� . .. <br />Amount of <br />Increase <br />$ r <br />rease <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) .. <br />NewAmount <br />$ �.................... ... .�....._��.......�....... <br />Increase % <br />Total Percent of Change: <br />Decrease ( /o ........ <br />Time Extension Amount: <br />New Completion Date: <br />