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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/21/2019 <br />Department Public <br />Name Becca Plantz Works _ <br />Extension . ..... <br />BPW Date 5/28/19 Phone E <br />5998 ...... ,.....w m...... ...,.�. <br />�""��"��'^�"� '. p r�umiHiHiHUHUHUHUHuwmuiuiuiuiui�uurt!�v° �,�m ur�vvv�... m000mimimimimom�uuwium,!�rorar�rvmuw,�e�n����mm�w„�vnr���iwmw�mw� <br />RRwired Prior to Submitta <br />l al to Board <br />BPW Attorney Attorney Name Clara Mcaniels <br />Dept. Attorney ❑' Attorney Name <br />Purchasing <br />Check the A <br />Item Type --- Required ffir All Submissions <br />❑ Professional Services Agreement Contract <br />Open Market Contract ❑ Amendment/Addendum <br />Bid Opening ❑ Bid Award <br />EJ Quote Opening ❑ Quote Award <br />E] Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. 1 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 />Purpose/Description <br />Required Information <br />Proposal <br />n Special Purchase, QPA <br />Fj Req. to Advertise <br />Reject Bids/Quotes <br />❑ PCA <br />El Resolution <br />Ease.../Encroach...�.� <br />Brown & Brown <br />❑ Y s❑ If Y s� Approved by PurchasingW <br />Y <br />® No <br />[� MBE Completed E-Verify Form Attached <br />❑ WBE <br />Ben _ ix Theater Lift at Ce <br />nt: <br />118-036C <br />Hotel Motel ............... <br />Tax Fund ,� �.._..................�...... �..�.... <br />7304.42010.000.0099 <br />❑ Title Sheet <br />Lump Sum _ <br />Cd time. <br />❑ Yes <br />❑, No <br />- <br />.... � � .._..w <br />�� For ti,a � Orders Only �.... .. <br />Amount of ® <br />m.m.._ m....... _ w_ �,.....�. <br />Increase $ 9,550.77 <br />❑ <br />Decrease ($ <br />Previous Amount <br />$ 71,300.00 _ ..........................�.. ,.,,,,..�.................__� <br />.....�..�................�m..........................,.......... <br />Increase_......._���_ 13.4% <br />Current Percent of Change: <br />�_ �,..................... _...e.._ �,.......... . <br />Decrease�� <br />New Amount <br />..... <br />$ 80,850.77 <br />.wnncrease....._....._m13.4%�...___......�.... <br />. � ... ... �....�.�................................ <br />Total Percent of Change: <br />�� kw ....�_ . ..... <br />Decrease %) <br />Time Extension Amount: <br />1 � _ ..... <br />ays,,,,.,,,,,,_ <br />New Completion Date: <br />6/1/2019 <br />