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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date10/7/20 <br />Department <br />NameKyle SilveusEngineering <br />BPW Date10/13/20Phone Extension9083 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />Officer Name <br />and Inclusion Officer <br />BPWAttorneyAttorney Name <br />Dept. AttorneyAttorney Name <br />Purchasing <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: Right of Entry Ease./Encroach <br />Agreement <br />Required Information <br />Company or Vendor NameN/A <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 Name1201Western Ave. Sidewalk Vault Repair <br />Project Number 120-019 <br />Funding Source <br />Account No.N/A <br />AmountTBD <br />Terms of ContractRight of Entry Agreement <br />Purpose/DescriptionRight 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 />$ <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 />