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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 5, 2019 <br />Department Public <br />Name Scott Kree er Works <br />BPW Date November 12 2019 Phone Extension 9245 <br />Rpquired Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney r-] Attorney Name <br />Purchasing <br />Check the Appr prlat Item Type Requ re l r All Submissions <br />D Professional Services Agreement Contract <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />Bid Opening <br />❑ Bid Award <br />E] <br />Quote Opening <br />❑ Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />Z <br />Chg. Order, No. 3 <br />❑ Traffic Control <br />n Other: <br />Information <br />Company or Vendor Name Michiana Contracting, Inc. <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 />Proposal <br />Special Purchase, QPA <br />E] Req. to Advertise <br />Reject Bids/Quotes <br />H PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Yes If Yes, Approved by Purchasing <br />No <br />MBECompleted E-Verify Form Attached ❑ No <br />V'PA Restroom Remodeling <br />118-043R <br />.................... <br />471-113 8-452.42-01 <br />.......... _. ... .... ...... <br />Parks Bond I <br />Avoroval of C.O. #3 <br />For Change Orders Only <br />Amount of Increase $4,058.00 <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase 0.77% <br />Decrease % <br />$ $529308.82 <br />Increase_..................................8...02% <br />Decrease % <br />23 Das <br />New Completion Date: 10/11/2019 <br />