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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 9/16/20 <br />Department <br />Name Kyle Silveus <br />Engineering <br />BPW Date 9/22/20 <br />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 />Attorney Name Clara McDaniels <br />Dept. Attorney ❑ <br />Attorney Name <br />Purchasing ❑ <br />Check the Appropriate <br />Item Type — Required for All Submissions <br />❑ Professional Services Agreement <br />❑ Contract ❑ Proposal <br />❑ Open Market Contract <br />❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening <br />❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />® Quote Opening <br />❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening <br />❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. <br />❑ Traffic Control ❑ Resolution <br />❑ Other: <br />❑ Ease./Encroach <br />Required Information <br />Company or Vendor Name <br />TBD <br />❑ Yes❑ If Yes, Approved by Purchasing <br />New Vendor <br />❑ No <br />MBBE <br />❑❑ Yes <br />MBE/WBE Contractor <br />Completed E-Verify Form Attached <br />❑ No <br />Proj ect Name <br />Liberty Tower Exterior Renovations Phase II <br />Project Number <br />120-047 <br />Funding Source <br />RWDA TIF <br />Account No. <br />324-10-102-121-443001 <br />Amount <br />TBD <br />Terms of Contract <br />Purpose/Description <br />Phase II exterior improvements including EFIS, concrete repair, painting, <br />exterior lighting, and 7ch floor roof pavers <br />For Change Orders Only <br />Amount of ❑ Increase $ <br />❑ Decrease ($ ) <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />Increase % <br />Decrease ( % <br />Increase % <br />Decrease <br />New Completion Date: <br />