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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date: May 20, 2020 <br />Name: Kara Bovles Department of Public Works — Engineering Division <br />BPW Date: May 26, 2020 Phone Extension: 5933 <br />Required Prior to Submittal to Board <br />BPW Attorney X Attorney Name: <br />Clara McDaniels <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Check the Appropriate Item Type — Re uired or 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 />n Other: License Agreement n 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 />Information <br />Universitv of Notre Dame <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />® No <br />E] MBE <br />❑ WBE Completed E-Verify Form Attached ❑❑ Yes <br />No <br />CCTV at Three (3) City -Owned Signalized Intersections for 2020 <br />Presidential Debate <br />n/a <br />n/a <br />n/a <br />n/a <br />See agreement <br />Granting a license to Notre Dame for the installation, operation and maintenance of <br />three (3) CCTV equipment systems at Angela and Notre Dame Ave.; Angela and <br />Eddy Street; and Angela and Leahy Dr. <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 Completion Date: <br />