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Date 10/ 19/2020 <br />Name Toy Villa Department Engineering <br />BPW Date 10/27/2020 Phone Extension 5920 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ Officer Name <br />and Inclusion Officer <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Tvne — Reauired for All Submissions <br />❑ Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise <br />❑ Quote Opening <br />❑ Proposal Opening <br />❑ Chg. Order, No. _ <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 />Purpose/Description <br />❑ Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Information <br />Slatile Roofing & Sheet Metal <br />❑ Reject Bids/Quotes <br />® PCA <br />❑ Resolution <br />❑ Ease./Encroach <br />❑ Title <br />Sheet <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />E] MBE E] Yes <br />❑ WBE Completed E-Verify Form Attached ❑ No <br />Gemini at Colfax Exterior Renovations, Masonry <br />119-103B <br />RWDA TIF / WWDA TIF <br />324.1050.460.42.02 <br />$368,128.00 <br />Project Closeout <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <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 />