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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/17/2019 <br />To Villa Department Engineering <br />Name....__........ .._�....�...�... _._.. ..... ........ .... <br />BPW Date 12/19/2019 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />BPW Attorney F] Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the Anix-ornate Item Tvoe - Reenoil) <br />U Professional Services Agreement H Contract <br />F1 <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />Quote Opening E] Quote Award <br />Proposal Opening ® C/O & PCA No. <br />Chg. Order, No. ❑ 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 />All Submissions <br />LJ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Peerless Midwest <br />�... --------- <br />.......... --- ........ <br />❑ Yes If Yes, Approved by Purchasing <br />No <br />MBE <br />MBE Completed E-Verify Form Attached El Nos <br />Cleveland Well Field Refurbishments - Well Cleaning <br />....._......_. ......... <br />118-021 C <br />Riverwest TIF <br />324.1050.460.42.02 <br />$48,598.00 <br />Project Closeout <br />........ For Chas g Orders QrIl "�_____-..__:..._.. <br />Amount of ❑ Increase $ <br />® Decrease ($ 402.00) <br />Previous Amount <br />$ 49,0010,00 <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ 48,598.00 <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />80%) <br />0.80%) <br />