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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 12/03/2019 <br />Department Public <br />Name Zach Hurst Works <br />BPW Date 12/10/2019 Phone Extension 3057 <br />Requirgd Prior to Submittal to Board <br />BPW Attorney ❑ Attorney Name <br />Dept. Attorney <br />Z Attorney Name Sandi Kennedy <br />._........................................... _ ........ <br />Purchasing <br />Check the Appropriate Item T Te - Required for All Submissions <br />_ <br />Professional Services Agreement ❑ Contract <br />Proposal <br />❑ Open Market Contract <br />[:] <br />Amendment/Addendum <br />Special Purchase, QPA <br />❑ Bid Opening <br />E <br />Bid Award F <br />Req. to Advertise <br />❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award F Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ <br />PCA <br />F Chg. Order, No. <br />❑ Traffic Control <br />Resolution <br />® Other: Public Improvements <br />Ease./Encroach <br />Agreement <br />Required Information <br />Company or Vendor Name <br />�=l aad C` # ;- Bald Mountain L LC <br />New Vendor <br />........ <br />❑ Yes❑ If Yes, Approved by Purchasing <br />E] <br />No <br />MBE/WBE Contractor <br />F] <br />WBE Completed E-Verify Form Attached <br />No <br />Project Name <br />201 S Main (Barnes and Thornburg Building) <br />........_ <br />Project Number <br />Funding Source <br />RWDA TIF / Private Funding <br />Account No. <br />324.1050.460.42.01 <br />Amount <br />$140 45ft. ` -5„57!L , m � ".' L 0 <br />3 a - <br />Terms of Contract <br />GLC/BM to reimburse City, per a t. with ledeveloprnent Comm. <br />Purpose/Description <br />Public Improvements Agreement between GLC/BM and City <br />to ensure DrOD <br />reconstruction of public rit of way. <br />For Change Orders Onl <br />Amount of ❑ <br />❑ <br />......... ........ ........ <br />Increase $ <br />Decrease ($ <br />_. <br />Previous Amount <br />............................................... __ .................. <br />$ <br />...._._._... <br />Increase % <br />._-... ............. <br />......... <br />Current Percent of Change: <br />..... .-__ <br />Decrease <br />New Amount <br />$ <br />�.. ............. ....... ______ .......... <br />Increase % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Completion Date: <br />