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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/31/2020 <br />.........._..... _ .� <br />Name Toy Villa Department -Wit—le-cr <br />BPW Date 2/11/2020 Phone Extension 5920 <br />m m <br />�_ ..� � uit�d Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name µ. <br />Dept. Attorney ❑ Attorney Name <br />_...._ __ <br />Purchasing❑ <br />Check the Ap rol t°iatc Item T r e:- , <br />�] Professional Services Agreement ❑ Contract <br />[-1 Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />EJ Quote Opening ❑ Quote Award <br />Proposal Opening C/O & PCA No. <br />El Chg. Order, No. D 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/Descriot:i( <br />All Submissions <br />LJ Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />HomeWorks Construction, Inc.. <br />❑ If YesA Yes , .. _m _......._Purch___ _ __.—"_.__ _ pproved by asing <br />® No <br />❑ MBE Completed E-Verify Form Attached ❑ Yes <br />WBE �] No <br />Lafayette Building Cleanout <br />119-098 <br />RWDA TIF <br />324-1050-460-42.02 <br />....... _ <br />$13,550.00 _.. ....0 ...--.. <br />PEca,�ect Closeout <br />For Chan e Orders <br />...... ❑ ... $ .. <br />Amount of Increase Decrease <br />❑$ <br />Previous Amount $ <br />Current Percent of Change - <br />New Amount <br />M <br />Increase % <br />Decrease ( / <br />Increase % <br />Total Percent of Change: Decrease (%... <br />Time Extension Amount: <br />New Completion Date: <br />