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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/07/2020 <br />Department <br />Name ...... _Toy Villa _ Engineeringµ„ <br />BPW Date 01/14/2020 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing E] Michael Schmidt <br />Check theAI)propriate Item <br />LJ Professional Services Agreement Lj Contract <br />F Open Market Contract <br />El Amendment/Addendum <br />Fj Bid Opening <br />F-j Bid Award <br />Quote Opening <br />❑, Quote Award <br />E] Proposal Opening <br />® C/O & PCA No. 1 final <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 />uired Information <br />�r All Submissions <br />Proposal <br />Special Purchase, QPA <br />❑I, Req. to Advertise <br />Ej Reject Bids/Quotes <br />F-j PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Walsh & Kelly <br />[:] Yes[:] If Yes, Approved by Purchasing <br />Fj No <br />MBE Completed E-Verify Form Attached El No <br />WBE <br />2019 Community Crossings <br />119-015 <br />.. _ ...._ _........... ....... <br />Local Road. <br />and Bridge Grant <br />265.0608.431.36.10 <br />Unit Price <br />Closeout <br />For Change Orders Oitl; <br />Amount of ❑ Increase $ <br />Decrease 93 62 <br />Previous Amount ® $ 1,106,505.950 <br />..... ......... ......... <br />Increase 0.0% <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Decrease (2.72% <br />$ 1,076,412.33 <br />Increase 0.3% <br />Decrease (2.72% <br />New Com letion Date: <br />.__......� ..._....... ...-.......................... ........................ .. ....... <br />