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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/04/2020 <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.2 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 />Walsh & Kelly, Inc. <br />U YesU If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Michigan Street Reconstruction <br />118-075 <br />RWDA <br />324.1050.460.42.03 <br />_Prof ect <br />Closeout <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />® Decrease $65,988.74 <br />Previous Amount $ 1,937,594.60 <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 (3.41% <br />$ 1,871,605.86 <br />Increase % <br />Decrease (2.13% <br />