Change Order No 1-PCA - 2017 Lamppost Program Project No 117-011A - Martell Electric LLC

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 06/03/2019 Department Name Toy Villa En ineerin2 BPW Date 06/11/2019 Phone Extension 5920 r�mmmw�umuuu��.mmmmwmmmmvmvim�mvummmmmmwm0mm!wu rcsrMAMEuuMuMOMivaWrmM urorom;»irmwiofflymam mewr nog «. .. ,� iuww ;r w,�r;rmr�wr�raxr m�a� ............... ............ .............� ..� ........,................W.,......................... ww.�,.ww,.�..—_ .._..........�.�.�.�...... RNuire , Prior to Submittal to Board BPW Attorney ❑ Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type Requ r ed /br All Submissions [-] Professional Services Agreement ❑ Contract [�] Open Market Contract ❑ Amendment/Addendum ❑ Bid Opening ❑ Bid Award Quote Opening F� Quote Award Proposal Opening Z C/O & PCA No.l Final E] Chg. Order, No. E] Traffic Control El Other: Information Company or Vendor Name Martell Electric, LLC New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Purpose/Description u Proposal Special Purchase, QPA ❑ Req. to Advertise ❑ Reject Bids/Quotes ❑ PCA EJ Resolution Ease./Encroach Yes f If Yes, Approved by Purchasing No ❑ Title Sheet ❑ MBE Completed E-Verify Form Attached ❑ Yes ❑ WBE ❑ No 2017 Lamppost Program 117-011A COIT .......................................................... 404-0602-431.31-06 _.....� ...n..... �....... El increase or Change Orders Only Increase $ Amount of Decrease � — _...__._._._. __ __ ..... ........ _... Previous Amount $ 30,725.00 Increase Current Percent of Change: Decrease New Amount $ 27,550.00 Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: m.(3,175 y00,%).m.,...........................................................................................................m...m._........._... 10.33%