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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date3/19/2019...................................................................._...........................................�...................... . <br />Name Zach Hurst <br />Department Public <br />Works <br />BPW Date 3/26/2019 Phone Extension 3057 <br />,ui rW�m �Iw.amsi �mmimimPAPlimimmmuuummimimimmmmmmimimimmmmmmmm lu wii i mmmm owt� uoim000 mm0000mmmmn mime <br />—..........._...... ................................................... <br />�.. <br />..... mReguiredmPrior tommmSubmittal to Board ..... .. <br />BPW Attorney El Attorney Name <br />Dept. Attorney E Attorney Name <br />Purchasing �] <br />Check the Appropriate Item 'I yl e -- required lbr All Submissions <br />Professional Services Agreement D Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />EJ <br />Bid Award <br />❑ Quote Opening <br />Z <br />Quote Award <br />❑ Proposal Opening <br />C/O & PCA No. <br />E] Chg. Order, No. <br />E <br />Traffic Control <br />0 Other: <br />R+ ouired Information <br />L] Proposal <br />[] Special Purchase, QPA <br />Req. to Advertise <br />n Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Fuerbringer Landscaping and Design, Inc. <br />_. �.� ....................... � , �____._._..... <br />., � ................. <br />Approved <br />❑ If YesA pP y <br />New Vendor <br />No , <br />MBE/WBE Contractor <br />0 WBE Completed E-Verify Form Attached <br />Nos <br />Project Name <br />Lot 12 US 31 Ind m ustrial Park — Landscape Work <br />m <br />Project Number <br />119-029 <br />Funding Source <br />River West TIF <br />Account No. <br />324-1050-460-42.01 <br />Amount." <br />Terms of Contract <br />Purpose/Description <br />.. - <br />mm .. �_ <br />Quote award rdl�cs�a)i�wtion installation for the Sham...b. augh + d er <br />Sons building on Carbonmill Drive <br />For Change Orders Only <br />Amount of <br />Increase $— <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase......................................................%..................__......................._�w �..��_..� �.�...........................................................__� <br />_..,,.. _._....._�..._���� <br />Current Percent of Change: <br />....................................��_....r......... �mu__ <br />Decrease% <br />New Amount <br />....................................................................� __ _ .. ..... �.. <br />$ <br />Increase <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />