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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 07/06/2020 <br />Name Zach Hurst Department DPW <br />BPW Date 07/14/2020 Phone Extension 3057 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name <br />BPW Attorney ❑ Attorney Name <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 />I -I Other: I -I 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 />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />❑ MBE ❑ <br />Completed E-Verify Form Attached ❑ Yes <br />No <br />Tutt Street Brick Recovery <br />120-045 <br />DCI Admin — Other Prof Services <br />211-10-101-120-431000 <br />Lump Sum <br />Ouote reauest to remove and palletize bricks in vacated Tutt Street across <br />from CountyCoppty Jail. <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 />