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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/03/2019 <br />Name Toy Villa 00q Department Engineering <br />BPW Date 12/10/2019 Phone Extension 5920 <br />Pf <br />hie tai�'od Prior to Submittal to Board <br />--- ....... _ _vvvv <br />BPW Attorney Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing El <br />Check the Appropriate Item Type — <br />❑I, Professional Services Agreement ❑ Contract <br />Open Market Contract <br />El Amendment/Addendum <br />❑ <br />Bid Opening <br />F] Bid Award <br />Quote Opening <br />El Quote Award <br />Proposal Opening <br />❑ C/O & PCA No. <br />n <br />Chg. Order, No. <br />Traffic Control <br />Other: <br />----------------- <br />Reauired Information <br />All Submissions <br />U Proposal <br />F� Special Purchase, QPA <br />Req. to Advertise <br />E Reject Bids/Quotes <br />® PCA <br />Q� Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />HC3 LLC dba St Clair DeveloPt7ient <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE El es <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached <br />Project Name <br />510 S Main Street Building rovements .... ........ <br />Project Number <br />119-084 <br />Funding Source <br />EDIT / Grants & Subsidies Fund 433 Redevelopment General <br />Account No. <br />..... ............ _._. <br />408.1001.460.39.30 / 433.1050.460.39.30 <br />Amount$161,162.96 <br />.�.............. ____.............._ _._.........................-. <br />Terms of Contract <br />PuMos%ati.on. <br />..... _........ .. ..�... _. <br />Protect Closeout <br />For Chg ITITOrders Only <br />Amount of <br />Increase ............ _ _ .................. <br />❑ <br />Decrease ($ <br />Previous Amount <br />$ <br />_._..__............_. ........ ....... <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ .............. <br />....... <br />Increase % ... ........ ....._.................... <br />Total Percent of Change: <br />Decrease ( 0 <br />Time Extension Amount: <br />0 days <br />New Completion Date: <br />