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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 4/6/2020 Department Engineering <br />Name Sue Ellen Doudrick Phone Extension <br />BPW Date 4/14/2020 Phone Extension - <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance ❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Abbrobriate Item TvDe — <br />U Professional Services Agreement U Contract <br />❑ Open Market Contract ❑ Amendment/Addendum <br />❑ Bid Opening ❑ Bid Award <br />❑ Quote Opening ❑ Quote Award <br />❑ Proposal Opening ❑ C/O & PCA No. <br />❑ Chg. Order, No. ❑ Traffic Control <br />® Other: Water Service <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 />Information <br />Star 001, LLC <br />All Submissions <br />U Proposal <br />❑ Special Purchase, QPA <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Reject Bids/Quotes <br />❑ Resolution <br />❑ Ease./Encroach <br />❑ Ease./Encroach <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />Water Service Agreement for Star 001. LLC <br />DP 18-025 <br />N/a <br />n/a <br />n/a <br />See attached leizal agreement. <br />Water Service Agreement for Star 001, LLC to construct a water main from <br />Four Winds Casino to Star 001 property under Prairie Avenue to serve the <br />Star 001 property. The water main will become a public water main once the <br />terms of the agreement are met. <br />For Change Orders Only <br />❑ Increase <br />❑ Decrease <br />Current Percent of Change: <br />New Amount <br />Increase % <br />Decrease ( % <br />Increase % <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />