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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/17/2023 <br />Name Toy Villa Department Public Works <br />BPW Date 02/28/2023 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. ® PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />Milestone Contractors North <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />® No <br />MB❑ <br />MBE/WBE Contractor <br />❑ E Completed E-Verify Form Attached ❑ Neos <br />Project Name <br />East Bank Trail over Leeper Avenue Bridge Repairs <br />Project Number <br />121-075 <br />Funding Source <br />Insurance Claim <br />Account No. <br />PO-0018559 <br />Amount <br />$185,584.00 <br />Terms of Contract <br />Purpose/Description <br />Project Closeout <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($) <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease (%) <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease (%) <br />Time Extension Amount: 0 days <br />New Completion Date: 6/1/2023 <br />