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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/20/19 <br />Department Public <br />Name Becca Plantz Works <br />BPW Date 5/28/19 Phone Extension 5998 <br />imuHUH111uuuuuuu=i u�asu� Imommm mmmmmmmumuommmmmmumummnmmn umaamumwmuumuuuRE ommvMmoNmiNurerwEEM <br />Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney ] Attorney Name <br />Purchasing 0 <br />Check the Appropriate Item "l'ype -- <br />Professional Services Agreement Contract <br />E] Open Market Contract ❑ <br />Amendment/Addendum <br />E] Bid Opening E] <br />Bid Award <br />E] Quote Opening <br />Quote Award <br />[] Proposal Opening] <br />C/O & PCA No. <br />Chg. Order, No. 2 <br />Traffic Control <br />F ] 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 />uired Information <br />All Submissions <br />LJ Proposal <br />Special Purchase, QPA <br />Ed Req. to Advertise <br />E] Reject Bids/Quotes <br />F] PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />_... <br />Brown & Brown........ _ -------�...... _m .........ww- <br />❑ Yes❑ If Yes, Approved by Purchasing <br />® No <br />E] MBE Completed E-Verify Form Attached Yes <br />FJWBE] No <br />troom Remodel entury Center Lower Level Res .. . <br />118-082A <br />Liability Insurance <br />226-0419-672.43-02 <br />Lump Sum <br />(7,hane Order for an increase ITto-contract amount covering unfioresmmeell <br />additional items and services. <br />_.. -- <br />For Clang Orders t r l <br />Amount of ❑ Increase $ 9,831.34 <br />Decrease$ <br />Previous Amount $ 242,239.27 <br />Increase �......� 4..20................-w�____ m_............�.............................................................. �.......__ ......... <br />/o <br />Current Percent of Change: Decrease %) <br />New Amount $ 252,070.61 <br />Increase 5.7% <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Completion Date: <br />