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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/03/2019 _._...................._. <br />Name Toy Villa Department Engineering <br />BPW Date 12/10/2019 Phone Extension 5920 <br />Required Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing El <br />Check the ADDrooriate Item Tvoe --. <br />❑ Professional Services Agreement ❑ Contract <br />Open Market Contract Amendment/Addendum <br />Bid Opening F-I Bid Award <br />Quote Opening Quote Award <br />Proposal Opening ❑ C/O & PCA No. <br />Chg. Order, No. ❑ Traffic Control <br />El 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 />uired Information <br />All Submissions <br />L Proposal <br />❑ Special Purchase, QPA <br />Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Slatile Rooling and Sheet Metal Co,, Inc <br />_ .... .............................................. <br />............... <br />El Yes El If Yes, Approved by Purchasing <br />No <br />MBE <br />WBE Completed E-Verify Form Attached F] N s <br />315 & 319 W. Jefferson Exterior Renovations — Division A <br />119-064, Div. A................................................................... <br />........_......................_....._ <br />RWDA TIF <br />................... ............. ._................ <br />324-1050-460-42.02 <br />$55,812.00 ..... ...................................... <br />Project Closeout. <br />_._. <br />For Change Orders Ong <br />Amount of Increase $ <br />❑ Decrease �$ _�_ .................................................... <br />Previous Amount $ <br />_. _ ...................._ ...................M — ....... o <br />Increase /o <br />.................... <br />Current Percent of Change: Decrease _%_IT�ITITITITITITmmmmmmmmmmmIT m ww <br />New Amount $ <br />............. _.................. .... __.................. ....................... <br />. <br />Increase % <br />XXX Total Percent of Change: Decrease _._.%mmm........ <br />Time Extension Amount: <br />New .Co...... on Date: .... .......... —.-..._..______...______________.. <br />