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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date February 3 2020 <br />Department <br />Name Jacob M. Klosinski Engineering/Utilities <br />BPW Date Februarx 11 2020 Phone Extension Ext. 9496 <br />roman <br />.. --- -_-- -..... - ................. _..... — ........ <br />Review and Aval Required Prior to Submittal to Board <br />Diversity Compliance Officer Name Michael Patton <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Clara McDaniels <br />Purchasing ® Michael Schmidt <br />�m Check the Appropriate Item Type — RequiredJctr 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 ® Title Shee <br />❑ Quote Opening 0 Quote Award Reject Bids/Quotes <br />❑ Proposal Opening C/O & PCA No. [:] PCA <br />Chg. Order, No. ❑ Traffic Control F] Resolution <br />Other. ❑ Ease./Encroach <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 />died. Information <br />Ll YesLJ If Yes, Approved by Purchasing <br />❑ No <br />E] WBE MBE Completed E-Verify Form Attached F] Nos <br />CSO 003 Backwater Valve Replacement <br />119-113---------------- <br />Utilities Sewage Works Operations, Contractual Services Other <br />641-0630-793-6335 <br />Lump Sum <br />The Division of Engineering Requests the Board of Public Works approval <br />the Title Sh t armed 1 gest to Advertise for the subject project, The iro os <br />MWBE Goal for this project was reviewed on 01/29/2020 and determined t <br />be 5.00% Advertise 02/21 & 02/28/2020. Bid Oneninc 03/10/2020. <br />Increase $ <br />.......................................................................... ..... �,,.. .. <br />Decrease ($ ) t <br />.....a. . ... _...... w. ....... . .d......... _.. ww------ ..�................ �. <br />Increase % <br />Decrease /) <br />$ . .A+t"-,...��. <br />Increase % <br />Total Percent of Change: Decrease m� % <br />Time Extension Amount: <br />New Completion Date: <br />