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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 1/21/2020 <br />Department <br />Name <br />BPW Date 1/28/2020 Phone Extension 5920 <br />Review and , . °6va1 � ai t°et) Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney <br />Attorney Name <br />Purchasing <br />...... ..... <br />❑' <br />Check the Appno ri to Item "1' )e -- Requh <br />❑ <br />Professional Services Agreement ❑ Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑', Bid Award <br />E] <br />Quote Opening E] Quote Award <br />EJ <br />Proposal Opening Z C/O & PCA No. 1(final) <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 <br />LJ Proposal <br />[� Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />F] PCA <br />Resolution <br />J Ease./Encroach <br />❑ Title Sheet <br />F❑acelift�Pant� rgw & pP erwasly n.................... ...._.............. <br />Yes If Yes A roved b Purchasing <br />No <br />MBECompleted E-Verify Form Attached ❑ Nos <br />Colfax Water Works Building Repainting <br />118-055 _.......... <br />..... <br />-...... ... ..........._.... _.............. <br />Buildin Re air & Maintenance <br />620.0640.657.36.01 <br />$19,153.85 <br />_Project <br />Closeout <br />For Change Orders <br />Amount of <br />Increase $ <br />_ ........ <br />R <br />Decrease$ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />o......_._.....� <br />( /o) <br />New Amount <br />$ <br />_. <br />Increase <br />.. _ _................ <br />% <br />Total Percent of Change: <br />Decrease <br />o ) <br />( /o <br />Time Extension Amount: <br />137 Days <br />_M ..�......._ <br />..._ <br />New Completion Date: <br />11/04/2019 <br />