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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 05/20/2020 <br />Name Alicia Czarnecki Department Engineering <br />BPW Date 05/26/2020 Phone Extension 5903 <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 <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Abbrobriate Item TvDe — <br />All Submissions <br />U Professional Services Agreement U Contract U 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. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Information <br />Company or Vendor Name <br />Premium Concrete Services, Inc. <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MB❑ Yes <br />MBE/WBE Contractor <br />E Completed E-Verify Form Attached ❑ <br />❑ No <br />Project Name <br />2020 Curb & Sidewalk <br />Project Number <br />120-001 <br />Funding Source <br />MVH <br />Account No. <br />202-06-602-505-431000 <br />Amount <br />$202,213.00 (Divisions B1, B2, B3, C1, and D1) <br />Terms of Contract <br />Unit Price Not To Exceed <br />Purpose/Description <br />Award Divisions B1, B2, B3, C1, and D1 of 2020 Curb and Sidewalk <br />Program <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <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 />New Combletion Date: <br />