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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/02/2020 <br />Name Toy Villa Department Engineering <br />BPW Date 10/13/2020 Phone Extension 5920 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />❑ 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.l Final ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />Premium Concrete Services, Inc. <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />❑❑ <br />MBE/WBE Contractor <br />Neos <br />❑ WBE Completed E-Verify Form Attached <br />Project Name <br />2020 Curb & Sidewalk <br />Project Number <br />120-001 <br />Funding Source <br />MVH <br />Account No. <br />V00000181 <br />Amount <br />$ <br />Terms of Contract <br />Purpose/Description <br />_Project Closeout <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />® Decrease ($ 5,803.55) <br />Previous Amount $ 202,213.00 <br />Increase <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ 196,409.45 <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />87% <br />87%) <br />