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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 04/28/2020 <br />Department Engineering <br />Name Toy Villa <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.1(Final) PCA <br /> Chg. Order, No. Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor NamePemberton Davis Electric, Inc. <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 Name 2017-2018 Traffic Loops <br />Project Number 117-124 <br />Funding SourceLRSA <br />Account No. 251.0608.431.36.67 <br />Amount <br />Terms of Contract <br />Purpose/Description Project Closeout <br />_______________________________________________________________ <br />_______________________________________________________________ <br />_____________________________________________ <br />For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease ($ 38,542.00) <br />Previous Amount $ 55,400.00 <br />% <br />Increase <br />Decrease (69.57%) <br />Current Percent of Change: <br /> <br />New Amount$ 16,858.00 <br />% <br />Increase <br />Decrease (69.57%) <br />Total Percent of Change: <br />Time ExtensionAmount: <br />New Completion Date: <br />