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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date04/21/2020 <br />Department Engineering <br />Name Toy Villa <br />BPW Date04/28/2020 Phone Extension 5920 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br />Professional Services AgreementContractProposal <br />Open Market Contract Amendment/Addendum Special Purchase, QPA <br />Bid Opening Bid Award Req. to Advertise Title Sheet <br />Quote Opening Quote AwardReject Bids/Quotes <br />Proposal OpeningC/O & PCA No. 1(final) PCA <br />Chg. Order, No. Traffic Control Resolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE Yes <br />MBE/WBE Contractor Completed E-Verify Form Attached <br />WBE No <br />Project NameEdison Well #3A Rehabilitation <br />Project Number 119-097 <br />Funding Source Water Works – Source of Supply and Other Professional Services <br />Account No. 620.0640.602.31.06 <br />Amount <br />Terms of Contract <br />Purpose/DescriptionProject <br />Closeout______________________________________________________ <br />______________________________________________________________ <br />__________________________________________________________ <br />For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease ($ 4,550.00) <br />Previous Amount$ 66,900.00 <br />% <br />Increase <br />Decrease (7.30%) <br />Current Percent of Change: <br /> <br />New Amount $ 62,350.00 <br />% <br />Increase <br />Decrease (7.30%) <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />