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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/14/19 <br />Name Alicia Czarnecki/Pain Me er Department En ineerin / DCI <br />BPW Date 10/22/19 Phone Extension 5903 <br />a <br />,e irod Prior to Submittal to Board N <br />BPW Attorney Attorney Name <br />Dept. Attorney [❑ Attorney Name <br />Purchasing El <br />Check the Appropri4te, Item T , e ­ Requiredfibi, All Submissions <br />❑ Professional Services Agreement Contract Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum Special Purchase, QPA <br />E] Bid Opening ❑ Bid Award F-1 Req. to Advertise ❑ Title Sheet <br />Quote Opening 0 Quote Award ❑ Reject Bids/Quotes <br />Proposal Opening n C/O & PCA No. PCA <br />® Chg. Order, No. 1 ❑ Traffic Control Resolution <br />n Other: Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />HC3 LLC dba St Clair Dem nt <br />Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />®No <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached Nos <br />Project Name <br />510 S Main Street Building Improvements <br />.........._.._..........._........................................ <br />Project Number <br />119-084 <br />Funding Source <br />EDIT / Grants & SubsidiesmmF mmnd 33 Redevelopment _ ..n,.. <br />_ u 4 General <br />-------------- .----- .... _------- . <br />Account No. <br />408.1001.460.39.30 / 43.3.1050.460.39.30 <br />Amount <br />. <br />Terms of Contract <br />Purpose/Description <br />See attached summary of change order items due to <br />champed/unforeseen site conditions. <br />Amount of ❑ Increase $ 5...„319.46..... <br />❑ Decrease ....($............��.) ..m � .�....�.. <br />Previous Amount $ 149,485.00 <br />Increase 3.49% <br />Current Percent of Change: Decrease ( % <br />New Amount $ 154,704.46 <br />Increase 3.49% <br />Total Percent of Change: Decrease <br />Time Extension Amount: 0 days <br />New Completion Date: <br />