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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date January 15, 2020 <br />Department Public <br />Name Scott Kreeger Works <br />BPW Date Jan,uary'18 2020 Phone Extension 9245 <br />mwwwwmm <br />l�.e ulred Prior to Submittal to Board <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney El <br />Purchasing F <br />Check th <br />Attorney Name <br />Michael Schmidt <br />❑ Professional Services Agreement Contract <br />Open Market Contract Amendment/Addendum <br />Bid Opening Bid Award <br />E] Quote Opening Quote Award <br />Proposal Opening C/O & PCA No. <br />n Chg. Order, No. ❑ Traffic Control <br />Other: <br />All Submissions <br />LJ Proposal <br />El Special Purchase, QPA <br />El Req. to Advertise ❑ Title Sheet <br />Reject Bids/Quotes <br />❑ PCA <br />[❑ Resolution <br />Ease./Encroach <br />Company or Vendor Name <br />Sel c Construction Co., Inc. <br />...------------------- _....................w <br />El Yes El If Yes, Approved by Purchasing <br />New Vendor <br />Z <br />No <br />MBE ❑Yes <br />MBE/WBE Contractor <br />WBE Completed E-Verify Form Attached <br />❑ ❑ No <br />Project Name <br />Street Culvert Inlet <br />Project Number <br />_M120-01ain � w..._.......��......_��.....�......�. �.............. <br />6 <br />Funding Source <br />Sewer Contractual _........ - m._, <br />Account No. <br />641-0621-792.63-35_.........................................._W....... <br />Amount <br />$12,500 <br />Terms of Contract <br />Lump Sum ... _................. <br />Purpose/Description <br />Debris cleanout of Bowman Creek in addition to the culvert at South Main <br />St. <br />... <br />1~or�� Qr�i�rs <br />Amount of <br />Increase <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase <br />. % <br />Current Percent of Change: <br />Decrease <br />New Amount <br />$ <br />� <br />Increase.. �m.._....�.�.�.�.�.�.�.�.�.�.�.�.�.�.�.�.�.�........ <br />Total Percent of Change: <br />Decrease <br />Time Extension Amount: <br />New Completion Date: <br />