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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date December 1 20t9 <br />Name Charlotte Brach Public Works — Eng. <br />BPW Date December 10 2019 Phone Extension 9246 <br />Required Prior to Submittal to Board <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing <br />Check the Appropriate Item 'Type <br />U Professional Services Agreement ❑ Contract <br />Open Market Contract Amendment/Addendum <br />Bid Opening Bid Award <br />❑ <br />Quote Opening ® Quote Award <br />❑ <br />Proposal Opening ❑ C/O & PCA No. <br />j <br />Chg. Order, No. ❑ Traffic Control <br />Ej Other: <br />Company or Vendor Name Walsh & belly, 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 />All Submissions <br />Proposal <br />L_J Special Purchase, QPA <br />Req. to Advertise <br />E] Reject Bids/Quotes <br />0 PCA <br />Resolution <br />Ease./Encroach <br />Yesj] If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />MBE Completed E-Verify Form Attached ❑ Yes <br />[] WBE ❑ No <br />Fire Stations 10 & 2 Parking Lot Repairs <br />1........... ....... <br />Capital Improvements/Building Improvements <br />287-0902-422.42-02� <br />$92,700 <br />Base Quote plus Alternate No. 1 <br />.. _.. <br />ForChanA,q Orders Only <br />El <br />Amount of <br />Increase $_ <br />EJ <br />Decrease <br />Previous Amount <br />$ . <br />Increase <br />o /o _............. _ .... <br />Current Percent of Change: <br />Decrease— <br />_ <br />%)........ <br />New Amount <br />$ <br />......Increase <br />._.... �m......m w <br />%._.......�......._�..wmwm............ <br />Total Percent of Change: <br />Decrease <br />....._ �� <br />Time Extension Amount: <br />-(mmmmm-mmmmmmmm%) <br />New Completion Date: <br />