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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 06/03/2020 <br />Name Zach Hurst Department DPW <br />BPW Date 06/09/2020 Phone Extension 3057 <br />Required Prior to Submittal to Board <br />BPW Attorney ® Attorney Name Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <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. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />® Other: Dedicated ❑ Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Proj ect Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Rieth R <br />❑ Yes <br />Information <br />i Construction Com <br />If Yes, Approved by Purchasing <br />❑ No <br />El ❑ MBBE ❑ <br />Completed E-Verify Form Attached ❑ Yes <br />No <br />Cleveland Rd./Brick Rd. Pavement Improvements <br />119-045 <br />Purpose/Description This DI agreement memorializes Rieth Riley's use of a temporary concrete <br />plant on Ameritech Drive, and guarantees the City a performance bond in <br />case of any damage to Ameritech Drive during use. <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount <br />Increase <br />Current Percent of Change: Decrease <br />New Amount $ <br />Increase <br />Total Percent of Change: Decrease <br />Time Extension Amount: <br />New Combletion Date: <br />