HomeMy WebLinkAboutRequest to Advertise - 2020 Curb & Sidewalk Proj No. 120-001BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 04/06/2020
Name Alicia Czarnecki Department Engineering
BPW Date 04/14/2020 Phone Extension 5903
Review and Approval Required Prior to Submittal to Board
Diversity Compliance
and Inclusion Officer ❑ Officer Name
BPW Attorney ❑ Attorney Name
Dept. Attorney ❑ Attorney Name
Purchasing ❑
Check the Appropriate Item Type — Re uired or All Submissions
❑
Professional Services Agreement ❑ Contract
Proposal
Open Market Contract Amendment/Addendum
Special Purchase, QPA
Bid Opening Bid Award
><
Req. to Advertise ❑ Title Sheet
Quote Opening Quote Award
Reject Bids/Quotes
Proposal Opening C/O & PCA No.
PCA
Chg. Order, No. Traffic Control
Resolution
Other:
I
I Ease./Encroach
Required Information
Company or Vendor Name
❑ Yes ❑ If Yes, Approved by Purchasing
New Vendor
❑ No
❑ MBE
Yes
MBE/WBE Contractor
Completed E-Verify Form Attached
WBE
❑ No
Project Name
2020 Curb &
Sidewalk
Project Number
120-001
Funding Source
MVH
Account No.
202-0619-431.31-06
Amount
Terms of Contract
Purpose/Description
For Change Orders Only
Amount of ❑
❑
Increase $
($ 1
Decrease
Previous Amount
$
Increase %
Current Percent of Change:
Decrease ( %)
New Amount
$
Increase %
Total Percent of Change:
Decrease ( %)
Time Extension Amount:
New Completion Date
WARD OF PI,1311C WORKS
C / _
Gary A. Giloi.. IN -dent
Elizabeth A. Maradik. Member
11— J. D nau, Vtembe,
Jordan V. (Who s, Membei
Joseph R. Molnar, Member
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