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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/5/19 �....................... <br />_��_�.�......,�,�.__.�...��_..._����.._._..�....�..._.�. Department <br />Name Terri Swift/Sean Ward Streets/Sewers <br />BPW Date 11/12/19 <br />Phone Extension 7567 <br />Required Prior to Submittal to Board <br />_�....... _ _...__ ....-_. .... ..._ .. _u <br />BPW Attorney X Attorney Name <br />Clara <br />Dept. Attorney Attorney Name <br />Purchasing x0 Michael Schmidt <br />Professional Services Agreement LJ Contract <br />n Open Market Contract <br />❑ <br />Amendment/Addendum <br />❑ Bid Opening <br />Bid Award <br />❑ Quote Opening <br />Quote Award <br />[� Proposal Opening <br />C/O & PCA No. <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />Z Other: Ratify Quote Award <br />awarded under authority: <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 />Amount of <br />Previous Amount <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Comnletion Date: <br />LJ Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />E] Reject Bids/Quotes <br />PCA <br />Resolution <br />❑ Ease./Encroach <br />❑ Yes❑ If Yes, Approved by Purchasing <br />No <br />❑ WBE Completed E-Verify Form Attached Nos <br />Gate Replacement — Street Department <br />MVH/Sewage Ops & Maintenance <br />202-0607-431.3 6-01 /641-0621-792.3 6-01 <br />Gate damaged by wind during storm of 9/27-28; caused stress fractures tc <br />metal framework, twisted entire structure — not repairable. <br />Increase $ <br />Decrease A$ <br />Increase % <br />Decrease <br />Increase % <br />0 <br />Decrease /o ) <br />