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Date 10/14/2020 <br />Name Toy Villa Department Engineering <br />BPW Date 10/27/2020 Phone Extension 5920 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer Officer Name <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 <br />Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No.1(Final) PCA <br /> Chg. Order, No. Traffic Control Resolution <br /> Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name Premium Concrete Services, Inc. <br />New Vendor Yes If Yes, Approved by Purchasing <br /> No <br />MBE/WBE Contractor MBE <br /> WBE Completed E-Verify Form Attached Yes <br /> No <br />Project Name Walnut Grove and North Riverside Drive Traffic Calming <br />Project Number 119-071 <br />Funding Source LRSA <br />Account No. 251.0608.431.42.96 <br />Amount $81,336.00 <br />Terms of Contract <br />Purpose/Description _Project Closeout <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ 3,836.00 <br />($ ) <br />Previous Amount $ 77,500.00 <br />Current Percent of Change: <br />Increase <br />Decrease <br />4.95% <br />( %) <br /> New Amount $ 81,336.00 <br />Total Percent of Change: <br />Increase <br />Decrease <br />4.95% <br />( %) <br />Time Extension Amount: <br />New Completion Date: