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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/03/2020 <br />Name Zach Hurst Department DPW <br />BPW Date 03/10/2020 Phone Extension 3057 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance El and Inclusion Officer Officer Name <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Q <br />Check the A pro nat Item 1" r l? —vu <br />—.. —.... <br />❑ Professional Services Agreement Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ® Bid Award <br />Quote Opening [ Quote Award <br />E] Proposal Opening ❑ C/O & PCA No. <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 />Information <br />All Submissions <br />[_J Proposal <br />El Special Purchase, QPA <br />Req. to Advertise <br />Ej Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Du eck Yes R If YesaA Srove bheet etas Inc __ww__ <br />Approved y Purchasing <br />® No <br />MBE ® WBE Completed E-Verify Form Attached E] Yes <br />No <br />........._...................__ ............................. _ _.. ment Gemini at Colfax — Exterior Renovations — Roof Re lace m-� ..................... <br />119-103, Division A <br />�._.—.—................................................. ... <br />RWDA TIF.......... <br />3 -050-460-42.02 <br />_......�..................................................................._..........—�w..... <br />...................................................................... .......... <br />Lumn Sum <br />For Change Orders Qjjl <br />Amount of ❑ Decrease.....�$..................__..,����........._... <br />Increase $ <br />Previous Amount $ m..�.�....��������.....��............._..._ <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase % <br />Decrease m(� W% <br />Increase % <br />Decrease ( % <br />