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Date8/4/2020 <br />Department <br />Name Sue Ellen Doudrick Engineering <br />BPW Date 8/11/2020 Phone Extension <br /> <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPW Attorney Attorney Name Clara McDaniels <br />Dept. Attorney Attorney Name Clara McDaniels <br /> <br />Purchasing <br />Check the Appropriate Item Type – Required for All Submissions <br />Professional Services AgreementContractProposal <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 OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic Control Resolution <br />Other: Ease./Encroach <br />Required Information <br />Christopher J. Voros and Jennifer N. Morse-Voros Revocable Trust – <br />Company or Vendor Name TEMPORARY AND PERMANENT EASEMENT <br />Yes If Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBE Yes <br />MBE/WBE Contractor Completed E-Verify Form Attached <br />WBE No <br />Project NamePrairie Avenue Water Main Loop <br />Project Number 117-068 <br />Funding Source TIF Southside Development #1 <br />Account No. Fund 430 <br />Amount $5,000 <br />Terms of Contractlump sum <br />Purpose/DescriptionThe easements are needed for construction access and installation of the <br />proposed water main. <br />_______________________________________________________________ <br />______ <br />For Change Orders Only <br />$ <br /> Increase <br />Amount of <br /> Decrease ($ ) <br />Previous Amount$ <br />% <br />Increase <br />Decrease ( %) <br />Current Percent of Change: <br /> <br />New Amount $ <br />% <br />Increase <br />Decrease ( %) <br />Total Percent of Change: <br /> <br />Time Extension Amount: <br />New Completion Date: <br />