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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date_03/03/2020.....................................a.a. <br />Name Zach Hurst Department DPW <br />BPW Date 03/10/2020 Phone Extension 3057 <br />........... .._...... . . - _ _._....._... <br />Review and Approval Regtkired Pnor to Submittal to Board <br />Diversity Compliance ITITIT�IT-mITITITITITIT���u <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />0 <br />Check the <br />ale Item "i <br />Professional Services Agreement LJ Contract <br />—Re /tdre / rAllSubmissions <br />Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />® Bid Award <br />Quote Opening <br />❑ Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />❑ <br />Chg. Order, No. <br />❑ Traffic Control <br />0 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 />uired Information <br />LJ Proposal <br />❑] Special Purchase, QPA <br />E] Req. to Advertise <br />Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheei <br />Ritschard Bros.„ Inc. <br />��.............. _................. .... <br />Yes If. Yes, Approved by Purchasing <br />® No <br />®MBE Completed E-Verify Form Attached Nos <br />WBE <br />Gemini at Colfax — Exterior Renovations — Water Main <br />119-103, Division D <br />RWDA TIF._.._..................... <br />324-1050-460-42.02 <br />...................................................... <br />$67,457 <br />............................. <br />Lump Sum <br />__ For "���ut�,gc�OrderswwOnlw <br />Amount of El Increase ... $ �.......... ......^.......�....����... _. ���.....� <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />% <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ <br />mIncrease _...._W.. <br />Total Percent of Change: <br />Decrease <br />( % <br />Time Extension Amount: <br />.... <br />New Completion Date: <br />