Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 2/18/2020..__................ _..... w <br />Department <br />Name _......_.........Sue Ellen Doudrick_..... __.. ._.......... ..... <br />Engineering <br />BPW Date 2/25/2020 Phone Extension 5922 <br />�.__...._....... ___._._w .... _....... _........... <br />E ..... m .._w „w RNuired. Prior to Submittal to Board <br />_........ ........_. <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney F Attorney Name <br />Purchasing [� ...__.�...._...._.......� .....__........ <br />_...................._._................. Check the.. Appropriate Item 'I y.p`-:...._ <br />❑ Professional Services Agreement n Contract <br />[-1 Open Market Contract n Amendment/Addendum <br />Bid Opening Bid Award <br />�] Quote Opening ❑ Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />❑ Chg. Order, No. ❑ Traffic Control <br />❑ Other: <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />bi All Submission <br />[:] Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />[� PCA <br />Resolution <br />Ease./Encroach <br />Star 001, LLC <br />YesEJ <br />If Yes �...A.............__..._. Purchasi__...................._.� <br />Approved by ng <br />❑ No <br />❑ MBE Completed E-Verify Form Attached <br />❑ WBE <br />__� ) ..Extension <br />Prairie Avenue SR 23 Water Mai <br />DP 18-025 <br />n/a <br />® Title Sheet <br />❑ Yes <br />❑ No <br />Purpose/Description Title Sheet for the construction of a public water main extension to serve the <br />Star 001 development. Water main to extend from the Four Winds Casino si <br />to Star 001. <br />For C, ian e Orders Only <br />Increase <br />Amount of $ <br />Decrease <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( % _ ...... <br />New Amount <br />Increase <br />....� �._------------- <br />. <br />Total Percent of Change: Decrease /o) <br />0 <br />Time Extension Amount: <br />New Completion Date. ....... <br />