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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br /> <br />Date 8/31/2020 <br />Department Public Works <br />Name Toy Villa <br />BPW Date 09/08/2020 Phone Extension5920 <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 ContractProposal <br /> Open Market Contract Amendment/Addendum Special Purchase, QPA <br /> Bid Opening Bid AwardReq. to Advertise Title Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. PCA <br /> Chg. Order, No. Traffic ControlResolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor NameLarson-Danielson Construction Co., 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 Cleveland South Well Field Bulk Fluoride Tank Replacement <br />Project Number 118-021B <br />Funding Source Riverwest TIF <br />Account No. 324-1050-460.42-02 <br />Amount$29,885.00 <br />Terms of Contract <br />Purpose/Description Project Closeout. <br />For Change Orders Only <br />$ <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 Extension Amount: <br />New Completion Date: <br /> <br />