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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/28/2020 <br />Name Toy Villa Department Engineering <br />BPW Date 05/12/2020 Phone Extension 5920 <br />Required Prior to Submittal to Board <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 Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ® C/O & PCA No.l Final ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <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 />Pemberton Davis Electric, Inc <br />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />2017-2018 Traffic Loons <br />117-124 <br />LRSA <br />251.0608.431.36.67 <br />Project Closeout <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />® Decrease ($ 38,542.00) <br />Previous Amount $ 55,400.00 <br />Increase % <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Decrease (69.57% <br />$ 16,858.00 <br />Increase % <br />Decrease (69.57% <br />