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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7-31-2023 <br />Name Coby Deal/ Sean Ward <br />Department Streets <br />BPW Date <br />Phone Extension 6001 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />and Inclusion Officer <br />Officer Name <br />BPW Attorney ❑ <br />Attorney Name <br />Dept. Attorney x❑ <br />Attorney Name <br />Michael Schimdt <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type <br />— Re uired or All Submissions <br />❑ Professional Services Agreement <br />❑ Open Market Contract <br />❑ Bid Opening <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. <br />❑ Other: <br />❑ Contract ❑ Proposal <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />x❑ Quote Award ❑ Reject Bids/Quotes <br />❑ C/O & PCA No. ❑ PCA <br />❑ Traffic Control ❑ Resolution <br />❑ Ease./Encroach <br />Reauired Information <br />Company or Vendor Name <br />Avanti Flooring LLC <br />❑ Yes[:] If Yes, Approved by Purchasing <br />New Vendor <br />X❑ No <br />Yes <br />MBE <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached ❑ <br />❑ No <br />Project Name <br />Office Flooring Replacement <br />Project Number <br />Funding Source <br />202/ 641 50150 split <br />Account No. <br />202-06-602-503-422000 / 641-06-602-509-42200 <br />Amount <br />9,945.94 <br />Terms of Contract <br />Purpose/Description <br />To remove and replace all front admin office Carpet that is worn and stained <br />with new carpet and cove base for the entire Public Works Building at 731 S. <br />Lafayette Blvd. <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />