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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 02/14/2020 <br />�....._........._ <br />Name Tov Villa �J <br />Department Engi:neerin <br />BPW Date 2/25/2020 Phone Extension 5920 <br />R irAod Prior to Submittal to Board <br />BPW Attorney E] Attorney Name <br />Dept. Attorney EJ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item l' "-_ <br />Professional Services Agreement ❑ Contract <br />El Open Market Contract ❑ Amendment/Addendum <br />] Bid Opening ❑ Bid Award <br />Quote Opening El Quote Award <br />[] Proposal Opening ❑ C/O & PCA No. I (final) <br />R Chg. Order, No. ❑ Traffic Control <br />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 />qd.,16r All Submissions <br />Required Information <br />LJ Proposal <br />Special Purchase, QPA <br />Req. to Advertise <br />F] Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Ziolkowski Construction, Inc. <br />............. <br />...___ __ ..... <br />Yes If Yes, Approved by Purchasing <br />Z No <br />WBECompleted E-Verify Form Attached Nos <br />Fire Station #9 <br />_...... .__.... _............... <br />116-012 <br />2018 Fire Station #9 Capital <br />. <br />451.0901.422.42.02 _ M ...................... .............._....._..� <br />$3,681,702.50 <br />Project Closeout <br />For "h ,nge_Orders Ot <br />Amount of 1-1 Increase $ <br />El Decrease $ <br />Previous Amount $ <br />.................. <br />Increase % <br />Current Percent of Change: Decrease (%) <br />New Amount $ <br />Increase % <br />Total Percent of Change: Decrease%) <br />Time Extension Amount: <br />New Completion Date: <br />