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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/7/20 <br />Department <br />Name Kyle Silveus Engineering <br />BPW Date 10/13/20 Phone Extension 9083 <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 />® Other: Right of Entry ❑ 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 />Information <br />N/A <br />❑ Yes ❑ If Yes, Approved by Purchasing <br />❑ No <br />El MBE <br />❑ WBE Completed E-Verify Form Attached ❑ Yes <br />No <br />1201 Western Ave. Sidewalk Vault Repair <br />120-019 <br />N/A <br />.E <br />Terms of Contract Right of Entry Agreement <br />Purpose/Description Right of Entry Agreement to access the vault at 1201 Western Ave. The <br />vault adjoins the basement wall of the privately owned structure at 1201 <br />Western Ave. The project will partially demolish and fill in the unused <br />under -sidewalk utility vault found to be in need of repair. <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 />