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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01 /02/2020 <br />Name Toy Villa <br />Purchasing ❑ <br />_~~~Check the Appropriate Item T p <br />Agreement Amendment Fj Contract <br />Professional Services F Resolution <br />EJ Bid Opening E] Bid Award <br />F� Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ C/O & PCA No <br />❑ Ease/Encroach. ❑ Traffic Control: <br />Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Rea�uired Info <br />Department Public Works <br />Division/Bureau Engineering <br />l e fired for All Submissions <br />[� Proposal <br />Req. to Advertise <br />�I ' <br />Addendum <br />❑ Title Sheet <br />Division A: Precision Wall Systems, Inc. <br />._w_................. <br />1 Ye ❑ WB❑ If Yes, Approved ' y Purchasin .. <br />No Yes Name of Co.._ ipaq <br />__........... <br />Lafayette Building Exterior Renovation (Division A) <br />_..................... <br />117-100R„ Division A <br />RWDA <br />324-1050-460-42.02 <br />$237,812.00 _..................... <br />Purpose/Description Project Closeout. <br />❑ Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verif „Iran, etc. <br />Required For Chanqt,Orders Only <br />Amount of ............. Increase $.......-_____-..-- <br />[� Decrease $ <br />_................. ........__ _........ ...................... <br />Previous Amount $ <br />Current Percent of Change-, %o <br />New Amount $ .................. ........... <br />.._.... <br />W <br />Total Percent of Change: %uuuuuuuuu W <br />Dispersal After <br />Copy <br />Original <br />❑ <br />❑ <br />