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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date05/20/2020 <br />DepartmentEngineering/VPA <br />NameAlicia Czarnecki/Patrick Sherman <br />BPW Date05/26/2020Phone Extension5903 <br />Required Prior to Submittal to Board <br />BPWAttorneyAttorney Name <br />Dept. AttorneyAttorney Name <br />Purchasing <br />Check the Appropriate Item Type Required for All Submissions <br />Professional Services AgreementContractProposal <br />Open Market ContractAmendment/Addendum Special Purchase, QPA <br />Bid OpeningBid AwardReq. to AdvertiseTitle Sheet <br />Quote OpeningQuote AwardReject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic ControlResolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor NamePemberton DavisElectric, Inc. <br />YesIf Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBEYes <br />MBE/WBE ContractorCompleted E-Verify Form Attached <br />WBE No <br />Project NameMuessel Grove Public RestroomElectricalWork <br />Project Number 118-099B <br />Funding Source2018 TIF Park Bond Capital <br />Account No.452-11-206-289-444000-PROJ00000051 <br />Amount$2,983.00 <br />Terms of ContractNTE <br />Purpose/Description_Provide and install all electricalitems for Public Restroom renovation at <br />Muessel Grove Park.______________ <br />For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease($) <br />Previous Amount$ <br />% <br />Increase <br />Decrease(%) <br />Current Percent of Change: <br />New Amount$ <br />% <br />Increase <br />Decrease(%) <br />Total Percent of Change: <br />TimeExtensionAmount: <br />New Completion Date: <br /> <br />