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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/15/20 <br />Department <br />Name Kyle Silveus Engineering <br />BPW Date 6/23/20 Phone Extension 9083 <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 Clara McDaniels <br />Dept. Attorney <br />❑ <br />Attorney Name <br />Purchasing <br />❑ <br />Check the Appropriate <br />Item Type — Reuirec or All Submissions <br />❑ Professional Services Agreement <br />❑ Contract <br />❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum <br />❑ 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 />Reauired Information <br />Company or Vendor Name <br />University of Notre Dame Du Lac <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MB <br />❑❑ Yes <br />MBE/WBE Contractor <br />E Completed E-Verify Form Attached <br />❑ No <br />Proj ect Name <br />The Landings Development - Easements <br />Project Number <br />DP 18-098 <br />Funding Source <br />N/A <br />Account No. <br />N/A <br />Amount <br />N/A <br />Terms of Contract <br />N/A <br />Purpose/Description <br />Easements for public sanitary sewer and public water main <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 Completion Date: <br />