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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />02/03/2020 <br />Toy Villa <br />Department Engineering <br />BPW Date 2/11/2020 Phone Extension 5920 <br />BPW Attorney Attorney Name <br />. ......... . .... . ..... <br />Dept. Attorney Attorney Name <br />. .... . ....... ..... . .. . . ...... <br />Purchasing ❑ <br />Check the 6ppK2priate Item rv,r,)e <br />Professional Services Agreement El Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening Bid Award <br />Quote Opening El Quote Award <br />Proposal Opening El C/O & PCA No. <br />Chg. Order, No. E] 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 />Purnose/Descrintit <br />to Board <br />issions <br />LJ Proposal <br />El Special Purchase, QPA <br />D Req. to Advertise <br />El Reject Bids/Quotes <br />0 PCA <br />El Resolution <br />F1 Ease./Encroach <br />F1 Title Sheet <br />Elite Electrical LLC <br />--=Ve—so I —fY e-s-,—A p..... <br />..p. r —ov c' - d- —by <br />No Purchasing <br />❑ MBE Completed E-Verify Form Attached F] Yes <br />WBE [-I No <br />315 & 319 W. Jefferson Electrical R <br />. ... . ...... . .... <br />119-064, Div. D <br />RWDA TIF <br />�24- i. �50-4 �O-3 4 6-4 <br />$42,750.0 0 <br />Closeout <br />Amount of El increase $ <br />Decrease $ <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount, <br />New Completion Date: <br />