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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/16/19 <br />Department <br />Name Terri Swift/Sean Ward Streets/Sewers <br />BPW Date 10/22/19 Phone Extension 7567 <br />..... _ __ ..__...._ <br />R. Prior_........ ............................. ......... ......... ......... ......... ........ <br />BPW Attorney X Attorney Name <br />Clara <br />Dept. Attorney ❑ Attorney Name <br />Purchasing x❑ Michael Schmidt <br />Check the Amiropriate Item T ve —Required liar;• All Submissions <br />Professional Services Agreement ❑ Contract ❑] Proposal <br />Open Market Contract 0 Amendment/Addendum EJ Special Purchase, QPA <br />❑, Bid Opening E] Bid Award [:] Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening Z Quote Award E Reject Bids/Quotes <br />❑ Proposal Opening F-1 C/O & PCA No. F-1 PCA <br />Chg. Order, No. F1 Traffic, Control F ] Resolution <br />® Other: Allow Terri Sliw ift to ai I�i 1. �1"� ❑ Ease./Encroach <br />serve as an agent of BPW <br />of Nulic Workd <br />pursuant to 1 -1-1 _ <br />5 b 1 B with respect to <br />soliciting guotes for a gate <br />replacement at the Street <br />Dei)artment. -�. .. ' <br />Company or Vendor Name <br />New Vendor ❑ Yes[:] If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor ❑ WBE Completed E-Verify Form Attached ❑ No <br />Project Name Gate Replacement — Street Department <br />_..w . .w . <br />Project Number <br />Funding Source MVH/Sewage O s & Maintenance <br />Account No. 202-0607-431.36-01/641-0621-792.36-01 <br />Amount <br />Terms of Contract <br />Purpose/Description Gate damaged by • caused during storm of 9/27-28...... ....._...................._...................................- <br />stress fractures t( <br />metal framework, twisted entire structure — not repairable. <br />For ChanRe Orders Only' .. _ .. <br />❑ $ <br />Amount ofIncrease <br />..................................................�.............................................................................................................................................................................................................................................�....�....... <br />Decrease <br />Previous Amount $ <br />Increase % <br />Current Percent of Change: Decrease ( /o <br />New Amount $ <br />