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Date June 17, 2020 <br />Department Public <br />Name Sue Ellen Doudrick Works <br />BPW Date June 23, 2020 Phone Extension <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />❑ <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney <br />® <br />Attorney Name <br />Clara McDaniels <br />Dept. Attorney <br />® <br />Attorney Name <br />Clara McDaniels <br />Purchasing <br />❑ <br />Check the Appropriate <br />Item Type <br />—Required or All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control <br />❑ Resolution <br />❑ Other: <br />❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />Department of Public Works <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBE Yes <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ ❑ No <br />Project Name <br />Project Number <br />Funding Source <br />( ) <br />Account No. <br />Amount <br />$66,602.40 <br />Terms of Contract <br />Purpose/Description <br />Approve acquisition of easement interests in properties and authorize City <br />personnel to act on behalf of the Board for recordation of the <br />easements. <br />For Change Orders Only <br />Amount of ❑ <br />Increase $ <br />❑ <br />Decrease ($ ) <br />Previous Amount <br />$ <br />Increase % <br />Current Percent of Change: <br />Decrease ( %) <br />New Amount <br />$ <br />Increase % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />New Combletion Date: <br />