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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 /> <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 /> <br />Purchasing <br />Check the Appropriate Item Type Required for 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 Sheet <br /> Quote Opening Quote Award Reject Bids/Quotes <br /> Proposal Opening C/O & PCA No. Resolution <br /> Chg. Order, No. Traffic Control Ease./Encroach <br /> Other: Water Service Ease./Encroach <br />Agreement <br />Required Information <br />Company or Vendor Name Star 001, LLC <br /> Yes If Yes, Approved by Purchasing <br />New Vendor Completed E <br /> No <br /> MBE Yes <br />MBE/WBE Contractor Completed E-Verify Form Attached <br /> WBE No <br />Project Name Water Service Agreement for Star 001, LLC <br />Project Number DP 18-025 <br />Funding Source N/a <br />Account No. n/a <br />Amount n/a <br />Terms of Contract See attached legal agreement. <br />Purpose/Description 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 /> <br />For Change Orders Only <br />$ <br /> Increase <br />Amount of <br /> Decrease ($ ) <br />Previous Amount $ <br /> % <br />Increase <br />Decrease ( %) <br />Current Percent of Change: <br /> <br />New Amount $ <br /> % <br />Increase <br />Decrease ( %) <br />Total Percent of Change: <br /> <br />Time Extension Amount: <br />