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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 01/05/2021 <br />Name Zach Hurst Department DPW <br />BPW Date 01/12/2021 Phone Extension 3057 <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 Sheet <br />Quote Opening Quote Award Reject Bids/Quotes <br />Proposal Opening C/O & PCA No. 1 PCA <br />Chg. Order, No. Traffic Control Resolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name BSR Roofmasters <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 Burke Building Roof Repairs <br />Project Number 119-084A <br />Funding Source DCI Cumulative Capital Improvement <br />Account No.PO-0004343 <br />Amount $480.00 C.O., $6,770.00 Final Amt. <br />Terms of Contract Lump Sum <br />Purpose/Description Final C.O. to balance quantities, along with Project Completion Affidavit and <br />Waiver of Lien. <br />For Change Orders Only <br />Amount of Increase <br />Decrease <br />$ <br />($ 480.00) <br />Previous Amount $ 7,250.00 <br />Current Percent of Change: <br />Increase <br />Decrease <br />% <br />(6.6%) <br />New Amount $ 6,770.00 <br />Total Percent of Change: <br />Increase <br />Decrease <br />% <br />(6.6%) <br />Time Extension Amount: <br />New Completion Date: