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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 7 <br />Villa - 29 20.19 <br />2.1 ..— - -W.. <br />Name Toy Department: Engineering <br />BPW Date 08/13/2019 Phone Extension 5920 <br />uuuuuuuuuuuuuuuumrur�wr� w u rrtmmuuuumimiuummim�uuumwmmmmmumwwww�uwwww�wuu mwww �ww�uwwwu�uwwwuuwu�uwuuumEffa fflofmrsimiww iuI mmmm mm imimimimmmuuuummuuuuuuuuuwwmmmmmmumrmrmr�wmm ... ; uuummmmmmmm <br />c._..... .._..____.___................................_._ � l —Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />--------- A...�......a.._, � <br />Purchasing <br />Check the the ADDronriate Item Tvne — Reauirea <br />L Professional Services Agreement L Contract <br />E] Open Market Contract <br />Amendment/Addendum <br />Bid Opening <br />Bid Award <br />Quote Opening <br />Quote Award <br />Proposal Opening <br />C/O & PCA No. <br />® Chg. Order, No. 3 <br />Traffic Control <br />F-1 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 />Information <br />All Submissions <br />❑ Proposal <br />❑ Special Purchase, QPA <br />0 Req. to Advertise ❑ Title Sheet <br />EJ Reject Bids/Quotes <br />PCA <br />Resolution <br />Ease./Encroach <br />HRP Construction, Inc. <br />E] Yes If Yes, Approved by Purchasing <br />® No <br />❑ MBE Completed E-Verify Form Attached El Yes <br />❑ WBE No <br />Miami Street Basin Drainage Improvements <br />South Side TIF <br />430.1050.460.42.01 <br />proval of C.O. 113 <br />For Change Orders Only <br />Amount of z Increase $ 3,010.00 <br />❑ Decrease ($ <br />Previous Amount $ 501,,780.00 <br />.mmmm <br />�...................._. —.. _�..... Increase 0.60/o o....................................w�w�_ <br />Current Percent of Change: Decrease �A ...............................% a.............,�����w...,.,. <br />New Amount $ 504,790.00 <br />....Increase _�..�.2.39% . ........� .......... ...................�......................... <br />Total Percent of Change: Decrease R....°z������..—....................................w�..u........._�.1.............���._. <br />Time Extension Amount: <br />New Comnletion Date: <br />