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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date <br />Name <br />July 1y 7 �2019,LL....na.. _.,........ ......... <br />Charlotte Brach <br />Public Works - Eng. <br />BPW Date Jul 23 2019 Phone Extension 9246 <br />'d 19✓4W,1 IN'MAMMIINIINIIII ,�„� Nif�NMFlkkXfXf�/.fRfd��YRi RI A �nF+vzzwan +//�AFiI/k'... JdiM 'S1011YW W1 Mp91NNIVImmwumvrvNMlfi'4F/1E,NlJi/fim <br />�,�, �,�, www. ........,,w..... ..... ........ .......... - ...........m... <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing <br />Check the <br />❑IT] Professional Services Agreement <br />❑, Open Market Contract <br />Bid Opening <br />E] Quote Opening <br />❑ Proposal Opening <br />® Chg. Order, No. 1 <br />❑]_ Other: <br />ate Item T e --. <br />Contract <br />Amendment/Addendum <br />Bid Award <br />F] Quote Award <br />C/O & PCA No. <br />Traffic Control <br />All Submissions <br />E] Proposal <br />❑, Special Purchase, QPA <br />❑] Req. to Advertise <br />❑' Reject Bids/Quotes <br />❑] PCA <br />[� Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Re wired Information <br />Company or Vendor Name Walsh & Kelly, Inc. <br />�] Yes ❑d b If Yes, Approved ers...� � ���....._ ..... _.�.�� ...._ �...e._. <br />New Vendor prov� �ey Purchasing <br />No <br />MBE/WBE Contractor <br />❑❑ WBE Completed E-Verify Form Attached F Nos <br />Project Name <br />Civic Alleyway Repaving <br />Project Number <br />118-110 <br />Funding Source <br />�. <br />Complete Streets Transportation <br />Account No. <br />404-1001-460-42.30 <br />Amount <br />Terms of Contract <br />Base Quote <br />Purpose/Description <br />ff �_ ... <br />l.�......__. _...._ _�._._ __ For Change Orders Only _.. .._.._. <br />F. ... <br />Amount of Increase $ 3,355.00 <br />❑ Decrease $ ) <br />Previous Amount $ 50,692.51 <br />Increase 6.62% <br />Current Percent of Chane: Decrease %) <br />�.. .. __.. - ...... <br />New Amount $ 54,047.51 <br />Increase 6.62% <br />Total Percent of Change: Decrease %) <br />Time Extension Amount: <br />New Completion Date: <br />