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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 03/16/2020 <br />Name Toy Villa ✓ Department Engineering <br />BPW Date 03/24/2020 Phone Extension 5920 <br />_.._ <br />egui eel Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the <br />Professional Services Agreement <br />Open Market Contract <br />H Bid Opening <br />Quote Opening <br />F Proposal Opening <br />❑ Chg. Order, No. <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 />to Item.. ye <br />Contract <br />El Amendment/Addendum <br />Bid Award <br />0 Quote Award <br />[] C/O & PCA No. <br />❑ Traffic Control <br />Information <br />All Submissions <br />Proposal <br />E] Special Purchase, QPA <br />Q Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Cam rvice Outlet Inc. <br />❑ Yesm If Yes, Approved by Purchasing <br />No <br />MBE Completed E-Verify Form Attached ❑ Yes <br />(J WBE ❑ No <br />Bendix Theater Flooring <br />. . ....................._....�w_w <br />119-106 <br />Hotel Motel Tax Fund <br />7304.42010.000.0099 <br />$72,642.00 <br />Project Closeout <br />For Clhaq Orders Only <br />....... <br />Amount of <br />.._._ <br />Increase _.$._. _ ... ...... <br />(�Decrease <br />($ ) <br />Previous Amount <br />$ <br />....._........... _.....a.a. <br />....w <br />Increase % <br />..... <br />Current Percent of Change: <br />...... ........ _..... <br />Decrease ( % o) <br />New Amount <br />$ <br />Increase % �._�_���........... �_... <br />Total Percent of Change: <br />........... <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />