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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date10/2/2020 <br />Department Public <br />NameScott KreegerWorks <br />BPW Date10/13/2020Phone Extension9245 <br />Required Prior to Submittal to Board <br />BPWAttorneyAttorney NameClara McDaniels <br />Dept. AttorneyAttorney Name <br />PurchasingMichael Schmidt <br />Check the Appropriate Item Type –Required for All Submissions <br />Professional Services AgreementContractProposal <br />Open Market ContractAmendment/Addendum Special Purchase, QPA <br />Bid OpeningBid AwardReq. to AdvertiseTitle Sheet <br />Quote OpeningQuote AwardReject Bids/Quotes <br />Proposal OpeningC/O & PCA No. PCA <br />Chg. Order, No. Traffic ControlResolution <br />Other: Ease./Encroach <br />Required Information <br />Company or Vendor NameAsphalt Restoration Services <br />YesIf Yes, Approved by Purchasing <br />New Vendor <br />No <br />MBEYes <br />MBE/WBE ContractorCompleted E-Verify Form Attached <br />WBE No <br />Project NameNotre Dame Triangle Alley Paving <br />Project Number119-057R <br />Funding SourceStreet Maintenance <br />Account No.266-06-602-436008 <br />Amount$21,250 <br />Terms of ContractUnit Price <br />Purpose/Description______NTE_____________________________________________________ <br />_______________________________________________________________ <br />_______________________________________________________ <br />For Change Orders Only <br />$ <br />Increase <br />Amount of <br />Decrease($) <br />Previous Amount$ <br />% <br />Increase <br />Decrease(%) <br />Current Percent of Change: <br />New Amount$ <br />% <br />Increase <br />Decrease(%) <br />Total Percent of Change: <br />Time ExtensionAmount: <br />New Completion Date: <br /> <br />