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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date June 26,2018 <br />Name Carl Littrell Department DPW — Engineering <br />BPW Date Jul y 9110, 2018 Phone Extension 4,91 <br />Legal Attorney Name Clara McDaniels <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller El and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F1 <br />L] Agreement <br />0 Professional Services <br />F] Bid Opening <br />QI Quote Opening <br />F-1 Chg Order No. <br />Z Ease./Encroach, <br />F-1 Other: <br />Company or Vendor Name <br />7 1% Am N U.-T, Me <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />L Contract <br />El Amendment <br />❑ Bid Award <br />❑ Quote Award <br />❑ C/O & PCA No. <br />F-1 Traffic Control <br />a =6 <br />E] Req. to Advertise <br />PCA <br />Resolution <br />Claim <br />Yes LJ If Yes, Approved by Purchasing <br />No <br />Addendum <br />El Title Sheet <br />F'WBE F1 Completed E-Verify Form Attached F-1 Yes <br />No <br />Dollar General Store — South Michigan Street <br />DPO17-089 <br />HE <br />Purpose/Description The store developer, Zaremba Group, grants a perpetual access <br />easement across its property to allow Sewer Bureau access to <br />sewer that is in a separate easement behind the store. <br />Amount of F] increase $ <br />F] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />El H After recording — to Archives & GIS <br />0 F-1 Carrie L. Offtermatt, Zaremba Group, LLC. <br />M 0 Whitney Pizzala, AR Engineering <br />