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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/2/19 <br />........ ........ ....... .....--- <br />Name Alicia Czarnecki Department Eneinceri l <br />BPW Date 12/10/19 Phone Extension 5903 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑] Attorney Name <br />Dept. Attorney Attorney Name <br />.................. .......... <br />Purchasing ❑ <br />Ply _T�e......... <br />Check the A ro mate Item <br />M Professional Services Agreement F-1 Contract <br />❑ Open Market Contract Amendment/Addendum <br />❑ Bid Opening ® Bid Award <br />Quote Opening ❑ Quote Award <br />Proposal Opening C/O & PCA No. <br />[� Chg. Order, No. Traffic Control <br />Other: <br />__Be uired Information <br />All Submissions <br />Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />Reject Bids/Quotes <br />E] PCA <br />(] Resolution <br />E] Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Larson -Danielson Construction �: om r�ui <br />1 y, Inc <br />_.. �.. <br />If Yes, Approved by Purchasing <br />New Vendor <br />F', No <br />[_1 <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached Nos <br />Project Name <br />Pinhook Park Pavilion Improvements <br />Project Number <br />......... <br />118-077 <br />Funding Source <br />.... .... _ .......m <br />Park Bond H & J, DNR Grant _. <br />Account No. <br />471-m11m36-452.42-01 / 471-1138-452.42-01 <br />Amount <br />......................... _........_...._____ _.......................... <br />$164,571.00 (Base Bid Only) <br />Terms of Contract <br />mmm <br />NTE <br />Purpose/Description <br />...__� �.....o <br />Interiorr renovation of the existin .Pa_vilion at Pinhook Park.�..�_..w_.w <br />Amount of L] Increase $ <br />�❑ Decrease <br />Previous Amount $ <br />Increase <br />Current Percent of Change: Decrease ( % <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease ( IYO <br />Time Extension Amount:__._._._.... <br />New Completion Date: <br />