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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date06/03/2020 <br />Department Engineering/VPA <br />NameAlicia Czarnecki/Patrick Sherman <br />BPW Date06/09/2020Phone 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 Award Reject 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 NameD.A. Dodd, LLC <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 RestroomPlumbing Work <br />Project Number 118-099A <br />Funding Source2018 TIF Park Bond Capital <br />Account No.452-11-206-289-444000-PROJ00000051 <br />Amount$33,800.00 <br />Terms of ContractNTE <br />Purpose/Description_Provide and install all plumbingitems for Public Restroom renovation at <br />Muessel Grove Park.______________ <br />For Change Orders Only <br />$ <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 />Time ExtensionAmount: <br />New Completion Date: <br />